2111 management nurse jobs found

Company Description Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! Learn more about our unique benefit offeringshere. Want to know more? You can learn about life at Wellmarkhere. Job Description Use Your Strengths at Wellmark as a Utilization Management Nurse! This position will require the following schedule: Your choice of any three days between Monday-Friday, with Saturday and Sunday required. Average schedule of 8:00 am - 5:00 pm Central with some flexibility.* About the role: As a Utilization Management (UM)...

Job Description We are seeking a dedicated Utilization Management Nurse to provide members and healthcare providers with timely prior approval for services, procedures, and out-of-network referrals. This role requires obtaining necessary medical information to make clinical determinations based on appropriate medical policy or criteria, and completing post-service reviews for medical necessity and investigational purposes. Responsibilities Provide precertification and continued stay reviews for members in various healthcare facilities or home health care admissions. Assist facilities to ensure timely discharge plans and make referrals to Case Management for ongoing needs. Collaborate with healthcare provider staff to gather medical information and facilitate discharge planning. Influence and negotiate with providers to resolve utilization review issues and explore alternative treatment options. Process utilization management requests using clinical knowledge to...

Spine and Pain Management Nurse Practitioner or Physician Associate Opportunity in Washington, MO! Mercy Spine Center and Pain Management - Washington is powered by 2 Physicians and an engaged support staff focused on quality patient care. This Opportunity Offers Clinic Hours: Monday-Friday, 8am - 4pm Outpatient Clinic Full-time position Treating patients of all ages System-wide Epic EMR Comprehensive benefits including health, dental, vacation, 401K and CME Relocation assistance and Malpractice insurance Your life is our life’s work. This amazing practice is a part of Mercy Clinic a strong, physician-led and professionally managed multi-specialty group. With over 2,500 primary care and specialty physicians, Mercy Clinic is ranked one the largest integrated physician organizations in the country. Mercy, a four-time IBM Watson Health top five large U.S. health system in 2019, 2018, 2017 and 2016, is a faith-based organization and serves millions...

Location: Avera McKennan Hospital Worker Type: Regular Work Shift: Day Shift (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $34.00 - $51.00 Position Highlights Varied Shifts, Monday-Friday, 7:30am-4:00pm – can be flexible, occas wknd (6/7 weekends/year, no evening/nights) **This position may be eligible for a sign-on bonus up to $15,000 You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. A Brief Overview Facilitates the plan for an orderly transition of patients from the Med/Surg and medical ICU acute area settings to the next appropriate level of care. Works closely with physicians and payors...

Location: Avera McKennan Hospital Worker Type: Regular Work Shift: Day Shift (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $34.00 - $51.00 Position Highlights Varied Shifts, Monday-Friday, 7:30am-4:00pm – can be flexible, occas wknd (6/7 weekends/year, no evening/nights) **This position may be eligible for a sign-on bonus up to $15,000 You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. A Brief Overview Facilitates the plan for an orderly transition of patients from the Med/Surg and medical ICU acute area settings to the next appropriate level of care. Works closely with physicians and payors...

Duties The Registered Nurse duties include but are not limited to: Assists Veterans, family members, and caregivers with receiving the most appropriate options and services to meet their complex health care and housing needs. Coordinates care for a special population with highly complex health, mental health, and/or substance dependence/abuse and homelessness issues. Coordinates treatment planning with multiple providers across all levels and sites of care. Addresses psychosocial, as well as nursing and medical needs of patients and their families/caregivers, through participation in interdisciplinary patient care management practice. Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. Evaluates practice in an ongoing process, based on best evidence. Provides peers with informal constructive feedback for improvement. Fosters a safe and supportive environment conducive to the professional development...

Duties Quality Consultant - Accreditation Specialist Registered Nurse (RN) demonstrates leadership, experience, and creative approaches to improvement in quality-of-care outcomes. The Accreditation Specialist serves as a subject matter expert for all surveys required and performed within the Medical Center and all off -site locations. The QM Consultant demonstrates performance and leadership that is broad enough to improve the care for a group of patients. The QM Consultant is responsible for the documented outcomes at the program or service level. Program or service level outcomes must be broad and complex and can be demonstrated at any organizational level within a facility. Program is defined as a substantial coordinated group of activities impacting patients and/or employees. The QM Consultant is assigned responsibility for accreditation requirements and activities for the Medical Center and all off-site locations. The QM Consultant collects data, monitors staff...

Job Description Summary Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluation of appropriate health care services in conjunction with the physician treatment plan. Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effectiveness is maintained. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected...

Job Description: Supplemental Health Care is seeking experienced Registered Nurses (RNs) for an exciting contract opportunity at one of Boston’s top-ranked healthcare institutions. This prestigious teaching hospital in Boston, Massachusetts, affiliated with one of the nation’s most respected medical schools, is consistently recognized for its excellence in patient care, groundbreaking research, and leadership in medical innovation. Case Management Registered Nurse Contract Details: $2,320 – $2,599 per week* 18-week contract with possibility to extend AM shifts available RN would be working at a Harvard Medical School teaching affiliate, fostering professional growth and access to cutting-edge medical advancements This facility is recognized among the Best Hospitals Honor Roll, ranked #1 in Massachusetts and Boston, and named one of the Top 10 Hospitals in the U.S. Estimated weekly payment may include both taxable wages and tax-free reimbursements for...

Would you like to speak with a Nurse Recruiter? (https://outlook.office365.com/owa/calendar/WouldyouliketospeaktoaNurseRecruiter@henryfordhealthsystem.onmicrosoft.com/bookings/) At Henry Ford Hospital, all nurses strive to provide exceptional patient care every day. They are encouraged to participate in quality assurance activities, research and shared governance to make a difference in the care given to patients and families. Henry Ford Nursing uses evidence-based practice, professional practice standards and the Henry Ford Hospital Professional Nurse Practice Model to drive nursing practice. Thank you for your interest in Henry Ford Health! GENERAL SUMMARY: Under minimal supervision, facilitates the transfer of patients to Henry Ford Health in a safe, successful and efficient manner. Coordinates all aspects of patient transfers. Utilizes clinical expertise to prioritize patient transfers based upon urgency/acuity, mode of transportation (ground or air),...

Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) & eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. Help Duties In collaboration with the Service Chief/Clinic Manager, the incumbent practices as an RN in the Primary Care Clinic(s) as a Registered Nurse Care Manager (RNCM). The RN provides evidenced based health nursing to Veteran patients seen in the outpatient setting. This registered nurse will work in Primary Care in collaboration with the team. Duties include but are not limited to: Documents assessment and interventions by policy and practice...

Duties In collaboration with the Service Chief/Clinic Manager, the incumbent practices as an RN in the Primary Care Clinic(s) as a Registered Nurse Care Manager (RNCM). The RN provides evidenced based health nursing to Veteran patients seen in the outpatient setting. This registered nurse will work in Primary Care in collaboration with the team. Duties include but are not limited to: Documents assessment and interventions by policy and practice standards. Completes post-Emergency Department (ED)/Urgent Care and post-discharge phone calls within 2 business days, and documents results in patient's medical record. Actively manages a high risk registry which includes patients with elevated HgbA1C, hypertension, elevated LDLs, frequent hospitalizations/admissions, frequent visits to the ED/Urgent Care area, and those who are considered, by the team, to be at high risk for injury. Collaborate with the Team (Patient, Primary Care Provider, RN Care Manager, Clinical...

At Lowell General Hospital / Tufts Medicine, we’re saving lives, building careers, and reimagining healthcare. Ready to grow with us? Lowell General Hospital’s Pain Management Center cares for patients with acute or chronic pain that has not responded to conventional therapies. The center is led by board-certified pain management physicians along with a team of nurses, physical therapists and other professionals specially trained in a variety of techniques to manage pain. We are seeking a Registered Nurse that will: Provide professional nursing care to the pain patient and assist with procedures and recovery of post procedural patient. Maintain current knowledge in Pain Management in order to assess for and provide adequate pain management education for acute and chronic pain. Formulate an interdisciplinary approach to providing patient care, developing a plan of care, patient education and discharge planning. Collaborate with practitioners and inpatient...

At Lowell General Hospital / Tufts Medicine, we’re saving lives, building careers, and reimagining healthcare. Ready to grow with us? Lowell General Hospital’s Pain Management Center cares for patients with acute or chronic pain that has not responded to conventional therapies. The center is led by board-certified pain management physicians along with a team of nurses, physical therapists and other professionals specially trained in a variety of techniques to manage pain. We are seeking a Registered Nurse that will: Provide professional nursing care to the pain patient and assist with procedures and recovery of post procedural patient. Maintain current knowledge in Pain Management in order to assess for and provide adequate pain management education for acute and chronic pain. Formulate an interdisciplinary approach to providing patient care, developing a plan of care, patient education and discharge planning. Collaborate with practitioners and inpatient and...

Duties The Nurse Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex utilization processes. Practical experience in the application of UM methods and expertise in medical necessity review criteria. This position requires strong analytical skills and the ability to evaluate program structure, process, and effectiveness and recommend strategies for program improvement. Duties include: Responsible for participating in field UM program review activities and providing advanced clinical and administrative recommendations and consultation to local and VISN UM staff. Evaluates program structure, process, and effectiveness and recommend strategies for program improvement. Possesses comprehensive knowledge of clinical appropriateness, functions, processes, and principles of utilization management. Instructs UM staff in medical necessity criteria and...

Duties The Quality Management(QM) Consultant Registered Nurse (RN) focus on individual growth and development in practice with increased levels of self-direction in quality-of-care outcomes. The QM Consultant brings principals and theory with limited application of critical thinking skills. They participate in the exploration of outcomes at the program level. Program is defined as a substantial coordinated group of activities impacting patients and/or employees. The QM Consultant is assigned responsibility for their assigned quality management program area activities for the Medical Center and all off-site locations. The QM Consultant collects data, monitors staff compliance with relevant policies, directives, and standards, provides reports detailing trends, and provides direct staff support to all services in planning, designing, integrating, implementing, modifying, and administering, a comprehensive quality management program area. The QM Consultant participates in...

DATE POSTED: 5/6/2025 JOB TITLE: REGISTERED PROFESSIONAL NURSE V – Case Management RECRUITMENT NO.: KCH 25-327- PERMANENT/PART TIME 75% FTE JOB LOCATION: KONA COMMUNITY HOSPITAL – Utilization Management SALARY RANGE: $10,246 (SR-23; BU:09) JOB DUTIES: The Case Management department provides outcome-oriented patient care with an appropriate length of stay, use of appropriate resources based on specific case types, and coordination of an integrated system of settings, services, health care practitioners, and care levels that make up a continuum of care. The Registered Professional Nurse V (case Management Lead) primary purpose is to provide assistance to the director with tasks including, but not limited to: scheduling of staff, budget monitoring, PAS reports, and quality improvements within the department. This position will continue with regular case manager duties such as, outcome-oriented patient care with an appropriate length of stay, use...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods,...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods,...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods,...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods,...

MedPro Healthcare Staffing , a Joint Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment with one of our top healthcare clients. Requirements Eighteen months of recent experience in an Acute Care Case Manager setting Active RN License BLS Certifications Degree from accredited nursing program Benefits Weekly pay and direct deposit Full coverage of all credentialing fees Private housing or housing allowance Group Health insurance for you and your family Company-paid life and disability insurance Travel reimbursement 401(k) matching Unlimited Referral Bonuses up to $1,000 Duties Responsibilities The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient’s family and healthcare organization. Work is administered in a variety of settings, including HMOs, community health organizations, long-term care...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods,...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods,...