Top 6896 Rn utilization manager Jobs

RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $87.06 - $118.62 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
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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
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
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
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Sr. Manager of Member Engagement
Private Health Management —Remote
- $120,000 - $180,000 a year
- US work authorization
- Senior level
- Leadership
- Health insurance
- Dental insurance
Quick Apply
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
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
12d
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
RN Case Manager
Zócalo Health —Remote
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
InterQual Senior Clinical Education Consultant (RN) - Remote
Optum —Chicago, IL
- $91,700 - $163,700 a year
- Full-time
- Hybrid work
- Spanish
- Nursing
- RN License
- Health insurance
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
1d
Nurse Specialist II
Qlarant —Remote
- $56,055 - $83,665 a year
- Full-time
- Remote
- RN License
- Mid-level
- Bachelor's degree
Quick Apply
Market Physician Executive (MPE) - Atlanta, GA
Monogram Health Professional Services —Atlanta, GA
- On call
- Medicine
- Critical & Intensive Care
- Travel
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse - Case Manager
SSM Health —Lake Saint Louis, MO
- Part-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health insurance
Program Manager - Cardiac Rehabilitation
SouthEast Alaska Regional Health Consortium —Juneau, AK
- $36.46 - $51.29 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- BLS Certification
- Paid parental leave
- Disability insurance
Quick Apply
Nurse Manager - Telemetry
MountainView Regional Medical Center —Las Cruces, NM
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
10d
UM Case Manager/Appeals Coordinator
Havenwyck Hospital (UHS) —Auburn Hills, MI
- $60,000 - $69,000 a year
- Full-time
- Background check
- LMFT
- Nursing
- Loan repayment program
- Health insurance
Quick Apply
Service Line Manager (RN) Ambulatory Surgery Center Full Time Day
Jersey City Medical Center —Jersey City, NJ
- $127,512 - $165,766 a year
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Paid holidays
Registered Nurse (RN) Unit Supervisor CV Neuro ICU - Nights
Inova Health —Alexandria, VA
- $46.00 - $76.25 an hour
- Full-time
- Nursing
- Patient monitoring
- RN License
- Health insurance
- 401(k)
Quick Apply
4d

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RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days

John Muir Health -
Walnut Creek, CA

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Job Details

Full-time
$87.06 - $118.62 an hour

Qualifications

RN License
BLS Certification

Full Job Description

Job Description:

Job Profile Summary
The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team.

The RN Case Manager is expected to function within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management. The RN CM, SW and care transitions team work in a collaborative approach, along with the individual patient and or their caregiver, to remove barriers for the safe transition of the patient.

Education:

Associate's Degree Accredited School of Nursing or
Degree/Diploma Obtained - Accredited School of Nursing Required

Experience:

2 years Case Management or Equivalent Work Experience Preferred
3 years Nursing - Medical/Surgical Preferred or
3 years Nursing - Critical Care Preferred

Certifications/Licensures:

RN Registered Nursing - California Board of Nursing Required
BLS Basic Life Support - American Heart Association Required
ACM Accredited Case Manager - ACMA American Case Management Association or
CCM Certified Case Manager - CCMC Commission for Case Manager Certification Strongly Preferred

Skills:

Strong written and verbal communication skills. Effectively motivates teams.
Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
Working knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital. Specialized knowledge may be required for certain areas of practice.
Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management. Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc. Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
Ability to plan, organize, manage time and prioritize work in collaboration with others.
Ability to work independently and as a part of a multidisciplinary team.
Effective problem solving and conflict resolution skills.
Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety.
Leadership skills to delegate and provide direction/guidance to staff and hold others accountable.
Able to learn and work in a variety of computer programs, including EPIC, InterQual, Allscripts, and Microsoft Outlook.

Work shift: 0800-1630

Days worked per week: 5

Hours worked per day: 8

work schedule:

Sunday to Wednesday (week 1)

Sunday-Thursday (week2)

Work Shift:

08.0 - 08:00 - 16:30 No Waive (United States of America)

Pay Range:

$87.06 - $118.62 Hourly

Offer amounts are based on demonstrated/relevant experience and/or licensure.

Pay will be adjusted to the local market if hired outside of the Bay Area.

Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word ‘exempt’ on it.

Scheduled Weekly Hours:

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