Top 22 Utilization management nurse Jobs in Morgantown, Wv

Disease Management Coordinator
UHC United Hospital Center —Fairmont, WV
- Full-time
- Nursing
- RN License
- Hospital
Care Manager RN - Peak Health
PHH Peak Health Holdings —Morgantown, WV
- Full-time
- Nursing
- RN License
- Mid-level
Health Plan Care Manager (RN or LSW)
West Virginia Senior Advantage, Inc. —Grafton, WV
- Full-time
- Nursing
- RN License
- Hospital
Quick Apply
Registered Nurse Case Manager
Family Services of Marion and Harrison Counties —Fairmont, WV
- $25 - $30 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Mileage reimbursement
- Health insurance
Quick Apply
3h
Care Management RN
UNTWN Uniontown Hospital —Uniontown, PA
- Full-time
- Nursing
- RN License
- Hospital
Case Manager Nurse 20016
WVUH West Virginia University Hospitals —Morgantown, WV
- Full-time
- Nursing
- RN License
- Hospital
Supv Care Management
WVUH West Virginia University Hospitals —Morgantown, WV
- Weekends as needed
- Nursing
- RN License
- Licensed Clinical Social Worker
2d
Care Management RN
Uniontown Hospital —Uniontown, PA
- Full-time
- Nursing
- RN License
- Hospital
Supervisor Care Management, Registered Nurse
WVUH West Virginia University Hospitals —Morgantown, WV
- Weekends as needed
- Nursing
- RN License
- Licensed Clinical Social Worker
Supervisor
WVUH West Virginia University Hospitals —Morgantown, WV
- Weekends as needed
- Nursing
- RN License
- Licensed Clinical Social Worker
Nurse Manager - Perianesthesia -- SURGICARE -- Mon Medical Center Main Campus
Mon Health —Morgantown, WV
- Full-time
- Nursing
- RN License
- PALS Certification
5 East ICU Nursing Supervisor
WVUH West Virginia University Hospitals —Morgantown, WV
- Full-time
- Nursing
- RN License
- Bachelor of Science
Nurse Manager - Operating Room -- OPERATING ROOM -- Mon Medical Center Main Campus
Mon Health —Morgantown, WV
- Full-time
- Nursing
- Surgery
- RN License
Supv Nursing - 2W Pre/Post
WVUH West Virginia University Hospitals —Morgantown, WV
- Full-time
- Nursing
- RN License
- Hospital
NCCU Nightshift Supervisor
WVUH West Virginia University Hospitals —Morgantown, WV
- Full-time
- Nursing
- RN License
- Bachelor of Science
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care —Bruceton Mills, WV
- Full-time
- Nursing
- Heavy lifting
- RN License
- Tuition reimbursement
Appeal Analyst RN | Remote | Contract
Walker Healthforce, LLC —United States
- Contract
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
Quick Apply

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Care Manager RN - Peak Health
PHH Peak Health Holdings —Morgantown, WV
Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced…

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Disease Management Coordinator

UHC United Hospital Center -
Fairmont, WV

Apply Now

Job Details

Full-time

Qualifications

Collaborate with healthcare professionals
Patient follow-up care
Nursing
Clinical program implementation
Case assessment
Clinical program policy development
RN License
Health education for healthcare providers
5 years
Process design
Patient advocacy
Community resource coordination in health services social work
Patient financial aid assistance
Clinical audit and monitoring
Transitional care planning in clinical case management
Quality performance measurement
Policy & process development
Overseeing care coordination
Evidence-based practice
Clinical performance metrics
Utilization management
Clinical training
Team training
Clinical program monitoring
Client referral services
Clinical outcome improvement
Financial management in social service case management
Resource utilization in healthcare
Multidisciplinary team collaboration for treatment planning
Working with families

Full Job Description

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.

The Disease Management Coordinator collaborates with patients and primary care providers to ensure patients receive quality, efficient, and cost-effective healthcare services. Coordinates, monitors, and evaluates all options and services to optimize a patient’s health status.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate’s Degree in Nursing AND Seven (7)years clinical experience in a healthcare setting OR Bachelor’s Degree in Nursing AND Five (5) years clinical experience in a healthcare setting.

2. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact ( eNLC ).

3. State criminal background check and Federal (if applicable), as required for regulated areas.

4. Obtain certification in Basic Life Support within 30 days of hire date.

PREFERRED QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree in Nursing.

EXPERIENCE:

1. Prior care coordination experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Ambulatory Utilization Management, Financial Management and Quality Screening for assigned patients.

2. Identifies the targeted population and risk stratifies all patients to prioritize needs and direct interventions.

3. Communicates and collaborates with inpatient and outpatient case management to implement the discharge plan and coordinate a safe transition to the next level of care.

4. Works in collaboration with physicians/providers, patients, and their families to ensure safe and efficient transitions of care.

5. Works collaboratively with patients to design an individualized plan of care that ensures coordination of services by the healthcare team.

6. Collaborates with available social services for appropriate resource and financial management which may include, but is not limited to financial assistance coordination/referrals, entitlement program coordination/referrals, patient benefit coordination, assessment for appropriate usage of Health Care Resources/clinical cost efficiency.

7. Coordinates/facilitates patient progression throughout the continuum, Transitional Planning, Advocacy and Education:

8. Clinical performance improvement, outcome management and quality activities.

9. Uses data to drive decisions and plan/implement performance improvement strategies for assigned patients, including fiscal, clinical and patient satisfaction data

10. Implements clinical interventions based on risk stratification and evidence-based clinical guideline adherence and promotes best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up monitoring as needed.

11. Coordinates appropriate laboratory and diagnostic testing.

12. Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population

13. Participates in development, implementation, evaluation and revision of clinical pathways and other tools.

14. Educates the multidisciplinary team and physicians about clinical pathways/protocols and managed care principles

15. Works with leadership to design, implement, and evaluate a centralized care model that optimizes value. Works with leadership to continuously evaluate process, identify problems, and propose process improvement strategies

16. Monitors clinical and financial indicators on an ongoing basis and takes action to achieve continuous improvement in both areas.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office and clinical settings

SKILLS AND ABILITIES:

1. Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and health care team colleagues

2. Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change

3. Capable of independent judgment and action regarding psychosocial needs of patients.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Day (United States of America)

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

UHC United Hospital Center

Cost Center:

459 UPC Medical Center Whitehall

Address:

177 Middletown Road

Fairmont

West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Apply Now

Refine Your Search

utilization management nurse jobs in morgantown, wv

Disease Management Coordinator

Care Manager RN - Peak Health

Health Plan Care Manager (RN or LSW)

Registered Nurse Case Manager

Care Management RN

Case Manager Nurse 20016

Supv Care Management

Care Management RN

Supervisor Care Management, Registered Nurse

Supervisor

Nurse Manager - Perianesthesia -- SURGICARE -- Mon Medical Center Main Campus

5 East ICU Nursing Supervisor

Nurse Manager - Operating Room -- OPERATING ROOM -- Mon Medical Center Main Campus

Supv Nursing - 2W Pre/Post

NCCU Nightshift Supervisor

Dialysis Clinical Manager Registered Nurse - RN

Appeal Analyst RN | Remote | Contract

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Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.

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