Top 6244 Rn Utilization Manager Jobs

RN Utilization Management - Nights onsite
CHRISTUS Health (IHE/Hosted) —Corpus Christi, TX
- $31.70 - $47.00 an hour
- Full-time
- Background check
- Master of Social Work
- Nursing
- Health savings account
- Relocation assistance
Quick Apply
RN Care Manager - Case Management - Shoreline Hospital
CHRISTUS Health —Corpus Christi, TX
- $27.50 - $46.00 an hour
- Full-time
- Acute care
- Background check
- Master of Social Work
- 403(b) matching
- Relocation assistance
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Director, PACE Nursing Services
Fallon Health —Worcester, MA
- $160,000 - $165,000 a year
- Full-time
- Nursing
- 7 years
- RN License
RN, Clinic Nurse Supervisor
Immanuel —Windsor Heights, IA
- 8 hour shift
- Background check
- Nursing
- RN License
- Wellness program
- Health savings account
Home Health Director/Branch Manager (RN)
HealthView Home Health & Hospice —Yanceyville, NC
- Full-time
- Background check
- Nursing
- Management
- Disability insurance
- Health insurance
Quick Apply
5d
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
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RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Paid holidays
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Manager of Surgical Services
Green Mountain Surgery Center —Colchester, VT
- $90,000 - $110,000 a year
- No weekends
- Nursing
- Surgery
- RN License
- Free parking
- Health insurance
Registered Nurse Case Manager
Family Services of Marion and Harrison Counties —Fairmont, WV
- $25 - $30 an hour
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health insurance
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12d
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Director, Ambulatory Care Operations
HERITAGE PROVIDER NETWORK, INC. —San Bernardino, CA
- $145,000 - $150,000 a year
- Full-time
- Bilingual
- Nursing
- RN License
- Continuing education credits
- Paid holidays
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Licensed Practical Nurse - Calling New Graduates
Harmony Ridge Recovery Center, LLC —Walker, WV
- From $27 an hour
- Full-time
- CPR Certification
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Quick Apply
Director of Clinical Operations - Dialysis
American Renal Care, LLC —Mission Hills, CA
- $150,000 - $195,000 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
14d
Registered Nurse (RN) Case Manager - Care Management (Acute Care)
Albany Med Health System —Glens Falls, NY
- $39.83 - $59.74 an hour
- Full-time
- Acute care
- Nursing
- RN License
Relief RN Manager – PTO/FMLA Coverage
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- RN License
- Mid-level
- Bachelor's degree
- Travel reimbursement
- Disability insurance
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RN - Assistant Nurse Manager (8a-5p) MedSurg/6200-6300 - Johnson City, TN
Ballad Health —Johnson City, TN
- Weekends as needed
- Nursing
- RN License
- PALS Certification
Admissions Registered Nurse, RN
Lincoln Prairie Behavioral Health Center —Springfield, IL
- $35.99 - $44.99 an hour
- Full-time
- Nursing
- Psychiatry
- Addiction Medicine
- Continuing education credits
- Health insurance
Quick Apply
IV Infusion RN at Prime IV Hydration & Wellness
Prime IV Hydration & Wellness —Cedar Rapids, IA
- $45 - $55 an hour
- Full-time
- Nursing
- Vital signs
- RN License
Quick Apply
5d
RN/LPN Unit Manager
Confidential —Ocean County, NJ
- Full-time
- RN License
- Nursing home
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
5d
Clinical Manager - Registered Nurse
Enliven Home Health —Gahanna, OH
- $100,000 - $110,000 a year
- Full-time
- Background check
- Nursing
- RN License
- Free parking
- Paid training
Quick Apply
7d

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RN Utilization Management - Nights onsite

CHRISTUS Health (IHE/Hosted)
Corpus Christi, TX

Quick Apply

Job Details

Full-time
$31.70 - $47.00 an hour

Benefits

Health savings account
Relocation assistance
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching
Professional development assistance
Life insurance
Referral program

Qualifications

Inpatient
Utilization review
RN License
Managing patients as a nurse case manager
Pre-authorization review for utilization management
Case management
Utilization management
Clinical documentation
Acute care
Care plans
Medical terminology

Full Job Description

Summary:

The Emergency Department (ED) Care Manager is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Care Manager collaborates with the patient and/or family, multidisciplinary team, physicians, community partners, and payers to ensure the patient’s progress and level of care are appropriately determined. The Care Manager has well-developed knowledge and skill in patient status in the inpatient and outpatient settings and collaborates with other care managers, social workers, Patient Access, physicians, and administrative leadership in the ED to determine the appropriate level of care. The Care Manager also has a robust understanding of services and resources outside of the hospital that would be of benefit to the patient and initiates referrals as indicated. This work includes patient assessment and management, resource management, identifying patients appropriate for admission, observation or outpatient status, care facilitation, discharge planning with referrals to all levels of care, and other duties related to the defined population.

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Uses approved criteria to conduct patient assessment and admission clinical review to ensure the appropriateness of setting and timely implementation of the plan of care.
Performs review of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria set for appropriate level of care assignment.
Provides identification of patients for whom standard of care treatments could be safely rendered at home.
Screens appropriateness of admission including observation versus inpatient status.
Educates ED physicians and nurses about medical necessity and admission criteria.
Collaborates with physicians and other members of the treatment team on documentation needs and opportunities.
Utilizes high-risk screening criteria to make appropriate community and post-ED referrals.
Initiates prior authorization process when indicated for post-ED referrals and services.
Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
Manages high-use patients and works to find alternatives for care to frequent ED visits.
Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
Provides patient and family education and counseling about existing health problem-related care.
Anticipates barriers/variances to the delivery of care and intervenes as necessary.
Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
Coordinates and facilitates patient progression throughout the continuum.
Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
Able to analyze clinical information and accurately apply clinical criteria.

Education/Skills

Graduate of an accredited school of nursing (BSN preferred) or Master’s degree in Social Work (MSW) required

Experience

3+ years of relevant clinical case/care management experience in the acute care setting required
Familiarity with evidence-based medical necessity criteria sets required
Competency in prior authorization functions and software, including the application of criteria and timelines required
Proficiency in medical and managed care terminology required

Licenses, Registrations, or Certifications

RN license in the state of employment is required
Case Manager certification preferred
BLS preferred

Job Type: Full-time

Pay: $31.70 - $47.00 per hour

Benefits:

401(k)
401(k) matching
Dental insurance
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Professional development assistance
Referral program
Relocation assistance
Tuition reimbursement
Vision insurance

Experience:

Utilization review: 1 year (Required)

License/Certification:

RN License (Required)

Work Location: In person

Quick Apply

Refine Your Search

Rn Utilization Manager jobs

RN Utilization Management - Nights onsite

RN Care Manager - Case Management - Shoreline Hospital

Director, PACE Nursing Services

RN, Clinic Nurse Supervisor

Home Health Director/Branch Manager (RN)

UM Case Manager/Appeals Coordinator

RN Clinical Manager

Manager of Surgical Services

Registered Nurse Case Manager

HOME CARE - RN CASE MANAGER

Director, Ambulatory Care Operations

Licensed Practical Nurse - Calling New Graduates

Director of Clinical Operations - Dialysis

Registered Nurse (RN) Case Manager - Care Management (Acute Care)

Relief RN Manager – PTO/FMLA Coverage

RN - Assistant Nurse Manager (8a-5p) MedSurg/6200-6300 - Johnson City, TN

Admissions Registered Nurse, RN

IV Infusion RN at Prime IV Hydration & Wellness

RN/LPN Unit Manager

Clinical Manager - Registered Nurse

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