Nurse Manager II, Hospital Job at Bright Vision Technologies

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Registered Nurse (RN) - Active, current and unrestricted California License
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Nurse Case Manager

Becoming a Nurse at University Health is a great way to step up and be there for...

Location

United States , San Antonio

Salary:

36.00 - 66.00 USD / Hour

University Health

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Nursing is highly preferred
Three to five years nursing experience required (as a Staff nurse II or above)
Work experience in case management, utilization review or hospital quality is preferred
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required
An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement
Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred

Job Responsibility

Coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan of care for a patient within the acute episode of care
Proactively facilitates interventions to assure timely delivery of services
Evaluates the effectiveness of interventions
Tracks variances and/or barriers in the plan of care
Functions as the patient advocate to identify and communicate health care needs

What we offer

Medical: Excellent coverage for individuals and families with very low premiums and co-pays, and ZERO co-pays for medications filled at University Health
Dental
Vision
Pet insurance
Flexible and health spending accounts
Paid Time Off (PTO): Generous accrual rates that start on day one
Retirement: 457(b) and 403(b) deferred compensation programs
Education Reimbursement: College tuition reimbursement up to $600 per semester, continuing education up to $400 and certification reimbursement
Life and Disability: Basic life paid by University Health, with optional plans for life and disability insurance
Health and Wellness: Employee discounts, including gym memberships, employee health clinic, healing arts program, community events

Parttime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Excellent time management and priority-setting skills
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Quality Management Nurse Specialist RN II

The Quality Management Nurse Specialist RN II is responsible for overseeing the ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of clinical experience as an RN in an acute hospital setting
Must have excellent written and verbal communication and presentation skills
Ability to manage projects independently and assume responsibility for successful completion
Ability to develop and maintain strong working relationships with internal and external clients/ customers /members
Must have excellent analytical skills, working knowledge of statistics and reporting
Must be detail-oriented and effective critical thinking skills
Proficient in Microsoft Office (Word, Excel)
Strong interpersonal skills and high level of professionalism
Ability to work independently and within a team environment

Job Responsibility

Overseeing the clinical aspects for quality improvement projects/activities
Ensuring program activities are completed in a high quality and timely manner and ensuring compliance with all regulatory guidelines
Leads and/or participates in multi-department/cross-functional committees and work groups which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management
Develops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas
Develops and/or maintains relationships with other external organizations to expand key partnerships
Creates, maintains and implements training/education and supporting documentation for internal and external clients/customers/members
Develops and submits regulatory reports at the time and in the manner required by state or federal agencies such as Centers for Medicare and Medicaid Services(CMS)
Conducts/ performs clinical review of assigned potential quality issue cases (PQI), and close cases within regulatory timeframe, and presents appropriate cases to the peer review committee for action and resolution
Perform other duties as assigned

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Social worker assistant

The Nursing Home Placement Coordinator provides a centralized resource for all N...

Location

United States of America , Rochester

Salary:

24.22 - 33.91 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

BS or BSW + no experience OR No Bachelor’s degree but does have 4 years of experience
Experience in a health care setting preferred
Excellent communication skills (written and verbal)
Patient focused, advocacy skills and interdisciplinary collaboration preferred

Job Responsibility

Provide direct and indirect services to patients who are in need of placement in a post hospitalization after care facility
Coordinate communication with nursing homes regarding patient care needs, financial profile and other components of the patient's application or admission
Provide placement consultation to Social Work staff, community facilities, community or hospital physicians, other health care professionals, and, when indicated, to patients and/or families
Maintain Social Work Division liaison relationships with area nursing facilities and insurers
Receive and review initial or updated information from SMH Social Workers intended for placement purposes, and transmit the information to appropriate community facilities
Negotiate with individual facilities
Collaborate with Hospital interdisciplinary team, patient and family, as needed, to ensure optimum, timely placement of all patients
Problem solve on case specific or systems issues with Social Work Senior Director, leaders and individual Social Workers, or others as indicated
Facilitate the Placement Program’s inpatient throughput
Ensure the Program’s compliance with regulatory requirements & provide education to interdisciplinary team, patients & families

Parttime

Utilization Management Admissions Liaison RN II

The Utilization Management (UM) Admissions Liaison RN II is primarily responsibl...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
Minimum of 7 years of clinical experience in an acute hospital setting
Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team
Knowledge of personal computer, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs
Establishes and maintains ongoing communication with internal stakeholders and external customers while securing the L.A. Care member's admission or inter-facility transfer
Applies clinical expertise and the nursing process to triage and prioritize admission acuity, servicing as an expert clinical resource for patient placement while utilizing medical knowledge and experience to facilitate consensus-building and development of satisfactory outcomes
Continually seeks new ways to improve processes and increase efficiencies
Completes all inpatient and discharge planning requests appropriately and timely including, but not limited to: Skilled nursing facility, outpatient needs (home health, physical therapy, infusion), and case management referrals
Performs prospective, concurrent, post-service, and retrospective claim medical review processes
Performs other duties as assigned

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Registered Nurse II

The Nurse Supervisor is responsible for providing general patient care according...

Location

United States , Norfolk

Salary:

Not provided

Old Dominion University

Expiration Date

May 01, 2026

Requirements

Registration in Virginia as a registered nurse or valid compact/Multi-state License
BLS/CPR for Health Providers Certification
Graduate of an accredited Bachelor of Science or Master’s degree in nursing program from an institute of higher education
Considerable nursing experience in a hospital or outpatient healthcare setting and ambulatory setting, preferably adult/adolescent medicine, or college health
separate from clinical experience obtained while seeking a nursing degree
Demonstrated experience effectively communicating and engaging with varying audiences

Job Responsibility

Providing general patient care according to nursing protocols
Supervision of clinic support staff
Serving as a member of the Student Health Services Leadership Team
Serving as the Infection Prevention and Control Coordinator
Providing input for policy, procedure and process changes or revisions in collaboration with the Clinical Supervisor and Medical Director
Contributing to collaborative development and implementation of clinic policies, procedures, and workflows to continuously maintain accreditation standards and readiness
Supervision of clinical support staff to include but not limited to: scheduling, managing leave requests, timesheet approvals, performance evaluations, and general supervision of direct reports medical assistants and LPN’s
Overseeing inventory and ordering of clinical supplies/medications
Providing nursing skills and functions to support and maintain clinic readiness while overseeing patient flow
Supporting and participating in Allergy and Immunization compliance and provide cross coverage needs, QI, Risk Management, and peer review initiatives

Fulltime

Nurse Manager II, Hospital

Bright Vision Technologies

Location:
United States

Category:
Nursing

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 16, 2026

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