The RN Utilization Management Lead (RN UM) is an onsite position responsible for overseeing the daily operations of the utilization management team to ensure effective, timely, and compliant review processes for medical necessity, prior authorization, eTARs, denials management, concurrent and retrospective review activities. Contacts insurance for pre-authorization prior to conversion; collaborates with CM RN to obtain order for admission if appropriate. Monitor daily workflow for timely completion of authorization reviews (pre-certification, concurrent, post-service). Ensure appropriate application of clinical guidelines (e.g., InterQual, MCG) and regulatory standards (e.g., CMS, NCQA, URAC). Other duties as assignedsuch as denials management and appeals in lieu of other UM duties.
LanceSoft is seeking a travel nurse RN Case Management for a travel nursing job in Detroit, Michigan.. REQUIRED: Minimum 5 years of Inpatient Case Management experience (this does not include telephonic, utilization management, or therapy experience),. current valid MI RN licensure or LMSW with current valid MI licensure.. Preferred: Experience in discharge planning, home health care, rehabilitative medicine, community health, or managed care.. LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.
Health Advocates Network - Nursing is seeking a travel nurse RN Case Management for a travel nursing job in Jackson, Mississippi.. RN – Case Manager Registered Nurse - Health Advocates Network is urgently hiring Case Manager RNs with at least 2 years of recent experience!. To apply for this job now or to find out more about other opportunities with Health Advocates Network, Inc. reply to this posting, contact us at or call/text XXX-XXX-XXXX. We can provide you unparalleled access to exciting career opportunities.. Refer a Registered Nurse for a $XXX.00 bonus opportunity!. By solving challenges, providing the best placements, and advocating for you, we stand to help you thrive and pave the path forward in your career.
HonorVet Technologies is seeking a travel nurse RN Case Management for a travel nursing job in San Pedro, California.. Note: 2-year acute medical Care Manager experience performing both roles of Care Coordination and Utilization Review and discharge planning, Interqual and Epic are all HARDSTOPS. Founded in 2015, HonorVet Technologies stands as a Service-Disabled Veteran-Owned Small Business (SDVOSB) , proudly certified by NaVOBA and the U.S. Department of Veterans Affairs.. Our mission goes beyond staffing—we are committed to transforming lives by addressing the critical unemployment challenges faced by veterans.. As a Joint Commission-certified clinical staffing agency , we deliver unmatched expertise in placing top-tier healthcare professionals—RNs, LPNs/LVNs, CNAs/CMAs, and NPs—across diverse facilities, including hospitals, clinics, rehabilitation centers, old-age homes, schools, correctional facilities, and more.
Anders Group is seeking a travel nurse RN Case Management for a travel nursing job in Morgantown, West Virginia. Specialty: Case Management ~ Discipline: RN ~ Start Date: ASAP ~ Shift: 8 hours, days ~ Employment Type: Travel Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. RN (Registered Nurse) Anders Group is a Joint Commission accredited staffing agency and stands out from other agencies by our commitment to making sure our travelers are given the best customer service. Health Insurance, Including a Buy-up Option Dental Insurance Vision Insurance ~ Life Insurance ~Licensure Reimbursement ~ CEU Reimbursements ~ Travel Reimbursements ~ Rental Car Allowances ~ Referral Bonus ~ You're committed to providing exceptional healthcare. Medical benefits ~ Dental benefits ~ Life insurance ~401k retirement plan ~ License and certification reimbursement ~ Referral bonus
Alto Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Jackson, Mississippi. This role offers the chance to impact patient care across all inpatient units in a fast-paced academic medical setting. Monday–Friday schedule (no weekends!). Posted job title: RN Case Manager - Discharge Planning.. Alto Staffing is a professional staffing, placement, and human resource firm that got its start in 2003.
Nationwide Therapy Group is seeking a travel nurse RN Case Management for a travel nursing job in Jackson, Mississippi.. Must be RN Case manager with at least 2 years Acute Care Management experience in discharge planning experience. “Nationwide Therapy Group offers Eligible Employees Benefits Package Comprehensive Healthcare Coverage (Medical, Dental, & Vision Plans) Supplemental Coverage (Accident Insurance, Critical Illness Insurance, & Hospital Indemnity) 401(k) Retirement Savings Life & Disability Insurance Employee Assistance Program Legal Support Auto & Home Insurance Pet Insurance Employee Discounts with Preferred Vendors". We are Joint Commission certified, and specialize in staffing all areas of nursing, therapy, and allied health in all 50 states.. We want to provide an agency experience that is easy and stress-free so you can focus on what you do best
First Connect Health is seeking a travel nurse RN Case Management for a travel nursing job in Melrose, Massachusetts.. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 09/08/2025 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Unit Notes 40 hours a week, M-F BSN preferred but not required Will consider someone without MA license, but Can't have CA or NJ license, or background hit.. That will delay license experience in MedSurg Setting, plus experience in discharge/utilization managment.. Acts as liaison with Medical Staff, other departments, patient and family members and community resources to facilitate the utilization management review/discharge planning process 950671 About First Connect Health At First Connect Health , we take pride in being a Joint Commission–certified healthcare staffing agency , headquartered in Newark, New Jersey.. Benefits Medical benefits Sick pay 401k retirement plan Weekly pay Referral bonus
Slate Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Santa Rosa, California.. Registered Nurse - Case Manager - CM -. Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation.. Strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.. Slate Healthcare is a premier travel healthcare staffing agency, connecting healthcare professionals with thousands of opportunities at top-tier hospitals and facilities across the country.
Fauquier Health is a 97-bed acute care hospital offering surgical services including robotics, a 24-hour Emergency Department, extensive medical imaging capabilities, and an Intensive Care Unit.. The hospital provides patient care for specialty services including Orthopedics and Spine, a Cardiac Catheterization Lab, and robotic-assisted surgery.. The fourth floor is devoted to the Family Birthing Center and Intermediate Care Nursery.. Patient population: adults/geriatric; ob/newborn. Dress code: scrub color navy blue; business casual or scrubs allowed
LifePoint is seeking a travel nurse RN Case Management for a travel nursing job in Warrenton, Virginia.. Fauquier Health is now a 97-bed acute care hospital offering surgical services (including robotics), a 24-hour Emergency Department, extensive medical imaging capabilities, an Intensive Care Unit and much, much more.. The Fauquier Health system offers patient care for a variety of specialty services including Orthopedics and Spine, a Cardiac Catheterization Lab, and robotic-assisted surgery.. The fourth floor of the hospital is devoted to our Family Birthing Center and Intermediate Care Nursery.. General Comments Please include candidate's full submittal packet LifePoint Health candidate submission form Resume Candidate Self Assessment Skills Checklist
Job Title: RN - Registered Nurse - Complex Case Manager - Care Coordination. ACMA accreditation is preferred and required within 3 years of hire.. Integrates evidence-based clinical guidelines, preventive guidelines, protocols, and other metrics in the development of treatment plans that are patient-centric, promoting quality and efficiency in the delivery of healthcare for complex care patient population.. Complex care manager works with Care Management Operations Team to stratify/ triage patients to the complex care team.. Communicate effectively with healthcare providers, patients, families and other stakeholders to facilitate care coordination, including Skilled Nursing Home visits and collaboration.
The Unit Clinical Care Coordinator Emergency Department (Unit C3-ED) is responsible for the management of emergency department admission flow, patient progression, care coordination, and discharge planning to achieve system efficiency.. Assesses ED patients clinical presentation to identify admission appropriateness, working DRG and target length of stay; proactively communicates bed need to the Hub to facilitate admission flow.. Leads clinical care team (RN, physician, ancillary staff, and social worker) in SNAP huddles (for ED holds) to identify patient progression and discharge barriers; assigns barriers to appropriate team member for resolution; identifies and escalates unresolved barriers to senior leadership; aligns care team toward discharge goals.. Manages all aspects of admission/patient progression/discharge in hospitals bed management / discharge planning system (i.e., bed requests, patient attributes/alerts, DRG/TLOS, barriers, escalations, etc.). Able to maintain a calm demeanor and command during times of crisis management.
Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR); Certified Case Manager within 2 years - Commission for Case Manager Certification (CCMC).. Maintain current knowledge of case management and utilization review trends including the entire continuum of care within and beyond hospital walls. Maintain data analysis, providing insight into critical benchmarks such as length of stay, readmissions, post-acute care metrics, etc.. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation’s highest honor for nursing care. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
The role of the inpatient utilization review (UR) registered nurse (RN) is to provide patient advocacy through appropriate utilization of resources.. In conjunction with the Medical Director/designee, attending physicians, and inpatient case management team, the UR RN is the overall planner of utilization efforts to efficiently manage care from admission to discharge.. The inpatient UR RN 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.. Previous experience in the use of software systems for inpatient documentation (i.e. EPIC) and inpatient clinical review criteria (i.e. InterQual,) required.. Able to work in a variety of computer programs, including EPIC, InterQual, Allscripts, and Microsoft Outlook.
Demonstrates skill in educating patient, family and interdisciplinary team regarding post-acute care options, status determination, and other care coordination services.. Registered Nurse with Bachelors of Science in nursing (BSN) degree or Registered Nurse with Associates degree in nursing (ADN) plus five years utilization review or case management experience required.. Registered Nurse with Masters of Science in nursing (MSN) degree or Registered Nurse with Bachelors in nursing (BSN) plus five years utilization review or case management experience required.. Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.. Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Parkland Community Health Plan's (PCHP's) Utilization Management (UM) Clinician is responsible for processing authorization requests for members requiring physical and/or behavioral healthcare for outpatient and inpatient service.. If primarily serving members with behavioral health needs, must have and maintain an unrestricted license such as a RN, LPC, LMFT, or LCSW in the State of Texas.. Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.. Care Coordination and Clinical Review Performs clinical utilization reviews of pre-authorization, concurrent and retrospective requests per clinical information submitted by providers using clinical criteria for medical necessity and appropriateness of care.. Identifies members that are high risk or who have conditions that may need service coordination or disease management and facilitates appropriate referrals.
Elliot Health Systems Care Coordination Department, located in Manchester, NH, plays a vital role in ensuring seamless, patient-centered care across the healthcare continuum.. Under the direction of the Director of Care Coordination, the Utilization Review RN (UR RN) is responsible for ensuring the effective and efficient use of hospital services in alignment with the hospitals utilization review plan.. Refer cases that do not meet admission or continued stay guidelines to the Utilization Review Physician Advisor after discussions with attending physicians.. Minimum of three (3) years of experience in hospital case management or utilization management.. CCM or ACM certification preferred.
Ardor Health Solutions is seeking a travel nurse RN Case Management for a travel nursing job in Morgantown, West Virginia.. Ardor Health Solutions is a Fortune Ranked, award-winning, expanding company that has also recently been ranked the 20th Largest Allied Staffing Firm in the Nation by Staffing Industry Analysts (SIA) and by Fortune`s Great Places to Work Survey s several years in a row.. Posted job title: RN Case Management 5x8 Days About Ardor Health Solutions Ardor Health Solutions formed in 2001 and remains a privately held medical staffing business owned and operated by the same family.. Over the years we have expanded our staffing and recruiting capabilities to include therapy services, nursing services, and all allied services.. Benefits Weekly pay Holiday Pay Pet insurance Referral bonus Employee assistance programs Medical benefits Dental benefits Vision benefits Benefits start day 1 License and certification reimbursement Life insurance Discount program
LeaderStat is seeking a travel nurse RN Case Management for a travel nursing job in Warrenton, Virginia.. Registered Nurse - RN in Warrenton, VA LeaderStat is currently seeking a Registered Nurse - RN with experience for a(n) 13 week contract in VA. Start Date: 9/15/2025 Shift: 08:30-16:30 Minimum of 18 months experience working as a full-time Registered Nurse Clinical experience within the last 2 years Current State Licensure Current Relevant Certifications (BLS, ACLS, etc) The LeaderStat Difference At LeaderStat, our recruiters are true experts in Travel Nursing.. Posted job title: Case Manager - Registered Nurse About LeaderStat LeaderStat is a National staffing, recruiting, and consulting firm dedicated to the healthcare industry.. Specializing in Travel Nursing, Interim Leadership, Executive Search, and Consulting.. Benefits Referral bonus License and certification reimbursement Medical benefits Holiday Pay Weekly pay 401k retirement plan