Top 6195 Rn utilization manager Jobs

RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Inpatient
Quick Apply
11d
Nurse Case Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $89,400 - $106,100 a year
- Full-time
- Nursing
- RN License
- Mid-level
RN Case Manager, Per Diem (SMH)
UCLA Health —Santa Monica, CA
- $93.83 - $98.52 an hour
- Per diem
- Nursing
- RN License
- BLS Certification
RN / Medical Reviewer / Remote
InGenesis —Columbia, SC
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
Clinical Review & Correspondence RN
Cohere Health —Remote
- $31 - $35 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health savings account
Quick Apply
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
RN Concurrent Review - UM - Remote - Kelsey Seybold Clinic
Optum —Pearland, TX
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
Quick Apply
Utilization Review RN
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Full-time
- Nursing
- RN License
- Hospital
Nurse Specialist II
Qlarant —Remote
- $56,055 - $83,665 a year
- Full-time
- Remote
- RN License
- Mid-level
- Bachelor's degree
Quick Apply
Oncology Prior Authorization Case Manager, Non-RN - Remote
University of Miami —Miami, FL
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
- Health insurance
- Dental insurance
Case Manager Nurse-RN
Personify Health —Remote
- $36 - $38 an hour
- Email
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
14d
Oncology RN Case Manager - Remote
Optum —Schaumburg, IL
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
Quick Apply
Case Manager RN
GLOBALHEALTH HOLDINGS LLC —Oklahoma City, OK
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Health insurance
Quick Apply
12d
CHS Utilization and Appeals Manager
Catholic Health —Melville, NY
- $110,000 - $150,000 a year
- Nursing
- RN License
- Word processing
- Health insurance
- Tuition reimbursement
RN Care Manager/UR - Remote - PRN
LCMC Health —New Orleans, LA
- Part-time
- Remote
- Nursing
- RN License
- Mid-level
Quick Apply

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RN Case Manager

MedStar Health -
Washington, DC

Apply Now

Job Details

Full-time
$89,065 - $162,801 a year

Qualifications

RN License
Managing patients as a nurse case manager
Utilization management
Decision making
Patient care
Resource utilization in healthcare
Negotiation

Full Job Description

About this Job:

General Summary of Position

Coordinates negotiates procures and manages care of our members/enrollees to facilitate cost effective care and members/enrollees satisfaction. Facilitates the continuum of care works collaboratively with interdisciplinary staff internal and external to the organization. Responsible for carrying a complex case management case load ownership of a case management program(s) pre- authorization reviews to provide Medically Necessary timely and quality health care services in the most cost-effective manner and pharmacy reviews per population served. This role would include the ability to meet memebers in their homes or various community settings. We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Provides face to face case management in the community as the member/enrollee's health necessitate.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy.
Monitors utilization of all services for fraud waste and abuse.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications
Education

Graduate of an accredited School of Nursing required and
Bachelor's degree preferred

Experience

1-2 years Case management experience required and
1-2 years UM or related experience required and
3-4 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and
CCM - Certified Case Manager Upon Hire preferred

Knowledge Skills and Abilities

Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Apply Now

Refine Your Search

rn utilization manager jobs

RN Case Manager

RN Team Lead Utilization Review

Nurse Case Manager, Utilization Management

RN Case Manager, Per Diem (SMH)

RN / Medical Reviewer / Remote

Clinical Review & Correspondence RN

Claims - Care Manager, RN, Claims

Denials & Appeals Administrator (RN)

Concurrent Utilization Review Nurse, RN

Utilization Review Nurse

Care Manager, Concurrent Review (Remote)

RN Concurrent Review - UM - Remote - Kelsey Seybold Clinic

Utilization Review RN

Nurse Specialist II

Oncology Prior Authorization Case Manager, Non-RN - Remote

Case Manager Nurse-RN

Oncology RN Case Manager - Remote

Case Manager RN

CHS Utilization and Appeals Manager

RN Care Manager/UR - Remote - PRN

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