- Adecco US, Inc. (Minneapolis, MN)
- …**Pay** : $40.00 - $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed ... benefit determination. . Generally work is self-directed and not prescribed. . The Utilization Management Nurse works under the direct supervision of an RN… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual + Milliman Commercial Guidelines… more
- CVS Health (Tallahassee, FL)
- …anywhere in the state of Florida. **Applicant must reside in Florida** . As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- CVS Health (Baton Rouge, LA)
- …is Monday-Friday, 8AM-5PM CST with weekend/holiday coverage required (as needed). As a Utilization Management Nurse Consultant, you will utilize clinical ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience...Qualifications** + 3+ years of experience as a Registered Nurse in a clinical setting. + Must have active… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Utilization Management Registered Nurse delivers fundamental knowledge-based care to assigned clients while developing ... Responsibilities Major Duties (To include but not limited to): The Registered Nurse Utilization Management Registered Nurse is focused on individual… more
- Humana (Charleston, WV)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** The Utilization Management (UM) Nurse Consultant is a remote, full-time role ... external stakeholders. The position also involves coaching healthcare staff on utilization management principles and contributing to policy development.… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- AdventHealth (Tampa, FL)
- …or designated leader for additional review as determined by department standards. The Utilization Management Nurse is accountable for a designated patient ... diseases. **The role you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise… more
- CVS Health (Annapolis, MD)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (Madison, WI)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Baton Rouge, LA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... from work._ **Required Qualifications** + 1 year of varied UM ( utilization management ) experience within an **outpatient** setting, concurrent review… more
- CVS Health (Harrisburg, PA)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in Eastern zones -BSN… more
- CVS Health (Columbus, OH)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** 2+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote- WFH **Schedule** - Mon-Fri Standard… more
- US Tech Solutions (Hopewell, NJ)
- … management principles. + Requires working knowledge of operations of utilization , case and/or disease management processes. - Requires knowledge of ... eligibility requirements. + Requires mentoring knowledge on the operations of utilization /case/disease management . **Education:** + Requires an associate or… more
- CVS Health (Annapolis, MD)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function + Gathers clinical information and applies… more
- Signature Healthcare (Louisville, KY)
- …communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. + Coordinate internal and external health ... What you Need to make a Difference + Registered Nurse (RN) in good standing with required current state...Previous experience with MDS and assessment preferred Hospital Case Management /Hospital Utilization Management . Obtaining… more
- CVS Health (Boise, ID)
- …procedures/services or initiate a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors ... meet quality and metric expectations. **Required Qualifications** + Registered Nurse (RN) - active license. + 3+ Years of...3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management… more