- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy +… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... medical directors/physician reviewers, network physicians, and network facilities to...most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker ... no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security** : Must possess… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …is seeking a highly motivated and results-oriented **Utilization Management ( UM ) Nurse ** . Our ideal ** UM Nurse ** will ensure timely review of ... policy, regulatory, and Health Plan guidelines. + Apply case management skills to members who have been identified as...medical standards of practice or experience with using UM medical criteria (ie Milliman and InterQual)… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Commonwealth Care Alliance (Boston, MA)
- …staff selection, training, and performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM program design, ... or Health related field preferred Required Licensing: - active RN license required Required Experience: - 7-10 years -...minimum five (5) years of leadership experience in Utilization Management ( UM ) or nursing leadership to include… more
- Commonwealth Care Alliance (Boston, MA)
- …responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... Audits, or EQRO reviews). - Hire, train and mentor UM staff, including nurse reviewers and support...reviewers and support personnel. - Act as liaison with medical director, provider relations, case management and… more
- Elevance Health (Las Vegas, NV)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... our Talent team at ###@mvphealthcare.com . **Job Details** **Job Family** ** Medical Management /Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200… more
- UPMC (Pittsburgh, PA)
- UPMC Home Health is Hiring a Full-Time Registered Nurse ( RN ) for the Uniontown and Surrounding Areas Are you a nurse looking for a rewarding career where ... patients' plans of care in collaboration with physicians, patients, and utilization management ( UM ) professionals to meet physicians' orders and patients' needs.… more
- CVS Health (Austin, TX)
- …on authorization trends, turnaround times, and team performance. **Required Qualifications** + Registered Nurse ( RN ) with an active and unrestricted ... platforms. + Knowledge of the regulations, standards, and policies which relate to medical management + Demonstrated ability to manage workload and meet… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (University Hospital-7B, Adult Cardiac and Medical Telemetry Unit) Apply Now **Mission Statement** Michigan Medicine improves the health of ... **Job Detail** **Job Opening ID** 266673 **Working Title** REGISTERED NURSE (University Hospital-7B, Adult Cardiac and Medical Telemetry Unit) **Job… more
- Magellan Health Services (Boise, ID)
- …Professional Counselor - Care MgmtCare Mgmt, PC - Professional Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - ... required: BCBA, LCSW, LMFT, LMSW, LPCC, LPC, PC or RN . If RN , BSN preferred but ASN...healthcare services in physical health, behavioral health or other medical specialty area based on pod management .… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (9C Adult Psychiatry Unit) Apply Now **Job Summary** The Adult Inpatient Psychiatry Unit (9C) offers inpatient diagnostic ... emphasize coordinating these recommendations with ongoing or subsequent psychiatric management . Patients also may be invited to participate in...Eighteen (18) months of recent psych experience as a Registered Nurse NOTE: In order to be… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (University Hospital-7A, Adult General Medicine/Telemetry Unit) Apply Now **Mission Statement** Michigan Medicine improves the health of ... opportunity employer. **Job Detail** **Job Opening ID** 269696 **Working Title** REGISTERED NURSE (University Hospital-7A, Adult General Medicine/Telemetry Unit)… more
- Ivyhill Technologies LLC (Bethesda, MD)
- … management process and the RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its...management systems. Will conduct reviews for capacity, capability, medical necessary, deferral to network, and right of first… more
- ERP International (Yuma, AZ)
- …(CRRN),(COHN), (ACCC), (CRC), ( RN -NCM),(CMC) **OR** Possess a Master's Degree in Nurse Case Management from a program accredited by the American Nurses ... **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for...databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case … more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : D. Dan and Betty...world and has been the site of many groundbreaking medical and technological advancements since the opening of the ... U-M Medical School in 1850. Michigan medicine is comprised of...employer. **Job Detail** **Job Opening ID** 270044 **Working Title** REGISTERED NURSE : D. Dan and Betty Kahn… more
- Vanderbilt University Medical Center (Nashville, TN)
- …negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-OthersLicensure-Others **Work ... is located in Medical Center North, on campus serving VUMC. Transition management or commonly referred to as care coordination is a thriving department comprised… more
