Top 6743 Utilization management rn Jobs

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Concord, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Tampa, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Miami, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Orlando, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
ISNP Utilization Management Nurse
Longevity Health —Remote
- $81,000 - $99,000 a year
- Full-time
- Nursing
- Clean driving record
- RN License
Quick Apply
11d
Clinical Guide Part A: Utilization Management Nurse
Devoted Health —Remote
- $85,000 - $95,000 a year
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
- Dental insurance
- 401(k)
11d
Utilization Management Nurse
Brighton Health Plan Solutions, LLC —Remote
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
14d
Health Nurse - Utilization Management
Alterwood Health —Remote
- $75,000 - $95,000 a year
- Full-time
- Microsoft Word
- Background check
- Nursing
- Health savings account
- Disability insurance
Quick Apply
14d
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
11d
Medical Management - Utilization Management RN 145-2011
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
11d
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
Medical Peer Reviewer
Healthfirst —Remote
- $122,907 - $188,020 a year
- 8 hour shift
- Medicine
- Mid-level
- Communication skills
- Paid holidays
- Health insurance
Medical Management - Medical Review Examiner Nurse 135-1009
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
11d
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
4d
Utilization Management Clinical Reviewer
CuraFi —Remote
- $140,000 - $160,000 a year
- Full-time
- RN License
- Senior level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
13d
RN Reviewer
Cohere Health —Remote
- $33 - $35 an hour
- Full-time
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Clinical Documentation Specialist
Managed Resources, Inc (MRI) —Remote
- $32 - $45 an hour
- Full-time
- Remote
- Anatomy knowledge
- RN License
- Mid-level
- Paid holidays
- Health insurance
12d
Utilization Review Nurse
Health Business Solutions LLC —Remote
- Remote
- Nursing
- RN License
- Bachelor of Science
13d

I want to receive the latest job alert for utilization management rn

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization management rn jobs near

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

John Muir Health -
Walnut Creek, CA

Apply Now

Job Details

Full-time
$89.23 - $121.58 an hour

Qualifications

RN License
BLS Certification
Bachelor's degree
Bachelor's degree in nursing

Full Job Description

Job Description:

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.

Education:

Bachelor's Degree Accredited School of Nursing Required

Experience:

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

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 know ledge of common diagnoses and procedures and the impact this w ill have to patients/families and their ability to manage their care outside of the hospital. Specialized know ledge 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 know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge 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, Allscripts, InterQual, and Microsoft Outlook.

Fixed Schedule:
Week 1: Sun-Wed
Week 2: Sun-Thurs

Work Shift:

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

Pay Range:

$89.23 - $121.58 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:

Apply Now

Refine Your Search

utilization management rn jobs

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

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

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

ISNP Utilization Management Nurse

Clinical Guide Part A: Utilization Management Nurse

Utilization Management Nurse

Health Nurse - Utilization Management

Medical Management - Utilization Management RN 145-2026

Medical Management - Utilization Management RN 145-2011

Denials & Appeals Administrator (RN)

Medical Peer Reviewer

Medical Management - Medical Review Examiner Nurse 135-1009

Utilization Management Nurse

Utilization Review Manager - PRN

Utilization Management Clinical Reviewer

RN Reviewer

Clinical Documentation Specialist

Utilization Review Nurse

I want to receive the latest job alert for utilization management rn

Related Searches

Explore jobs in more locations

Job Description:

Work Shift:

Scheduled Weekly Hours:

Job Seeker Tools

Employer Tools

Browse

Stay Connected