Milliman Utilization Review Jobs in Usa
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Unit Manager ( RN ) $10k Sign On BONUS
Working with us means being part of something special: A team that is passionate about making an impact on our patients’ lives each and every day. Unlike the typical hospital setting, our facility offers you the unique opportunity to walk alongside patients on their road to recovery from many different conditions. As you care for and help patients achieve goals and regain independence, you can form significant relationships with them and celebrate the successes they experience along the way.
- Competitive pay rates! Supportive Leadership!
- Exceptional LOW cost gold medical plan!
We are in search of a qualified RN Unit Manager:
- Assists in maintaining resident care standards by supervising and directing activities of subordinate nurses engaged in quality assurance, infection control, and utilization review activities.
- Receives physicians' instructions regarding resident care and ensures that orders are transmitted to other units as needed.
- Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates.
- Makes regular patient rounds to observe and assess residents’ physical conditions and behaviors, evaluates the quality of care provided, and ensures proper documentation of treatment and nursing observations.
Qualifications:
- Current R.N. license by State required with experience in the long term care or working with the geriatric population preferred.
- Must have at least two years nursing experience and one year supervisory experience.
- Clerical ability is necessary to read reports and utilize data accurately for other purposes.
- Skill in organizing and planning programs and managing personnel to provide nursing service for residents.
- Ability to plan and direct the department, coordinating with other departments.
We offer the following benefits for you and your family:
- Competitive Wages
- Elite Low Cost Gold Plan Blue Cross Blue Shield Health Insurance (low premiums and low deductibles!)
- Dental Insurance, Life Insurance, Vision Insurance
- 401K with company match
- Paid Holidays and Paid Vacation
- Best in class employee referral program
EOE
- $12,000 Sign-On Bonus (Full-Time)
- Competitive Pay based on experience
- Consistent Weekend Leadership Schedule
- Affordable Health, Dental & Vision Insurance
- Paid Time Off + Paid Holidays
- 401(k) with Company Match
Lead with Purpose. Make a Difference Every Weekend!
South Health and Rehabilitation, where we don’t just provide care—we create a supportive, compassionate environment where residents thrive and nurses lead with confidence. We’re looking for an experienced RN Weekend Supervisor who is ready to step into a leadership role and make a lasting impact.
Position Summary: Registered Nurse (RN) Weekend Supervisor The Registered Nurse (RN) Weekend Supervisor serves as the clinical leader responsible for overseeing resident care operations on the weekend rotation.
Qualifications:
- Current R.N. license by State required with experience in the long-term care or working with the geriatric population preferred.
- Must have at least two years of nursing experience and one year supervisory experience.
- Clerical ability is necessary to read reports and utilize data accurately for other purposes.
- Skill in organizing and planning programs and managing personnel to provide nursing services for residents.
- Ability to plan and direct the department, coordinating with other departments.
Key Responsibilities:
- Assists in maintaining resident care standards by supervising and directing activities of subordinate nurses engaged in quality assurance, infection control, and utilization review activities.
- Receives physicians' instructions regarding resident care and ensures that orders are transmitted to other units as needed.
- Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates.
- Makes regular patient rounds to observe and assess residents’ physical conditions and behaviors, evaluates the quality of care provided, and ensures proper documentation of treatment and nursing observations.
Benefits:
- Competitive wages for Registered Nurses (RN)
- Blue Cross Blue Shield Health and Dental Insurance
- Vision Insurance
- Life insurance
- Paid Time Off (PTO) and Paid Holidays
- 401(k) Retirement Savings Plan with Company Match
Professional Care. Purposeful Leadership. Lasting Impact.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
"Our Family Caring For Yours"
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
- Speech and Language Pathologists (SLP)
- Rehab (Days) Mound City, MO Description: Effectively screens/evaluates/rehabilitate patients with communication, cognitive or swallowing disorders and develops appropriate plan of care following all regulatory and clinical practice standards.
• Utilizes standardized assessments and evidence-based practice to support clinical interventions.
• Assesses patient s progress and adjust treatments accordingly in the clinical record per regulatory and clinical practice requirements.
• Evaluates treatment outcomes for effectiveness.
Services are modified in relation to patient evaluation and referrals are made in relation to outcomes.
• Provides consultation and counseling to patients, as well as families, caregivers and other service providers related to the speech disorders.
• Effectively communicates with supervisor and other health team members regarding patient progress, barriers, and treatment plans.
• Provides comprehensive discharge summary of services provided per regulatory and clinical requirements.
Documents all regulatory and clinically required information in the electronic documentation system and maintains patient records according to company policy • Accurately records treatment minutes for services provided per all regulatory and clinical requirements.
• Participation in required meetings including but not limited to: patient care conferences, utilization review meetings, rehabilitation meetings, etc.
• Participate in facility and company required trainings, in-services and conferences.
• Able to obtain any necessary DME or supplies per regulatory and clinical practice requirements.
• Able to supervise and support CFY or Student Speech-Language Pathologists • Adherence to ASHA and State Required practice acts, code of conduct, ethics during professional practice as a Speech-Language Pathologist.
• Active ASHA and State Licensure
*5, 40hr/wk.
Pay Range: $60/hr.
- $65/hr.
Stipends available for Traveler.
Locals are also accepted at reasonable pay.
Job Description: Coordinate patient care plans and ensure efficient resource utilization.
Perform comprehensive patient assessments and care planning.
Manage discharge planning and ensure continuity of care.
Collaborate with interdisciplinary teams for patient management.
Monitor compliance with external review agencies and regulatory standards.
Advocate for patients and address holistic care needs.
Support utilization review and case management functions.
Required Qualification: RN License of FL state or Compact.
BLS(AHA) is required.
2 years of Case Management Experience in Acute Care/ Hospital/ LTAC Setting.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
