- Humana (Columbus, OH)
- **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
- 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
- Humana (Tallahassee, FL)
- …and help us put health first** Humana Healthy Horizons in Florida is seeking a Utilization Management Nurse who utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 's work assignments are varied… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Management Nurse in Houston, TX! This role is hybrid with a mix of work from home ... 8am to 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Management Nurse :** . Responsible for the follow-up through for the… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage ... with occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse (RN) Position Responsibilities: + Works… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and ... department productivity to meet targets. + Participates in all aspects of utilization management . Assist with strategies, plans and workflow development in… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... Case Management through the American Nurses Credentialing Center or Utilization Management Accreditation through National Committee for Quality Assurance… more
- CVS Health (Columbus, OH)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area- + Managed Care experience preferred, especially Utilization Management + Preference for those residing in EST zones **Education** +… more
- CVS Health (Tallahassee, FL)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + UMNC meets set productivity and ... every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days...their Leader. **Required Qualifications** + Active and unrestricted Registered Nurse in state of residence + 3+ years of… more
- Omaha Children's Hospital (Omaha, NE)
- …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative,...Compact State Licensure Required and + RN-BC - Case Management Nurse Preferred Children's is the very… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...preferred. + An active OH or compact state Registered Nurse (RN) license in good standing is required. +… more
- Truman Medical Centers (Kansas City, MO)
- …time **Work Schedule** 7:00AM - 3:30PM **Hours Per Week** 4 **Job Description** ** Utilization Management Nurse (UM RN)** _Optimize Care. Improve Outcomes. ... log into myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Management RN Hourly (PRN) - Care Continuity -… more
- AdventHealth (Altamonte Springs, FL)
- …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... **Job Location** : Remote **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by… more
- St. Peters Health (Helena, MT)
- The Utilization Management Nurse reports directly to Utilization Review RN Coordinator. The UR Nurse supports the UR RN Coordinator in providing ... for the organization and is responsible for ensuring complaint utilization and cost-effective care delivery. The UR Nurse...serves as a collaborative and supportive liaison and educator to providers and staff around utilization management … more
- Nuvance Health (Danbury, CT)
- *Description* Summary: Required- Registered Nurse ( RN) The purpose of the Utilization Management Nurse is to support the physician, the ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review/ utilization management experience in an HMO, MSO, IPA, or health ... plan environment + Previous clinical experience + Experience drafting and issuing compliant adverse organization determinations + In-depth knowledge of health plan, DMHC, CMS, HIPPA, and NCQA requirements + Expertise in abstracting and interpreting medical… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare team, ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures...field required. Current registration as a Licensed Registered Professional Nurse in New York State. Two (2) to three… more
- McLaren Health Care (Lansing, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... and directed. _Required_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in nursing from accredited...the Military Training network (MTN) _Preferred:_ + Experience in utilization management /case management , critical care,… more
- McLaren Health Care (Petoskey, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... and maintenance of continuing education requirements **Preferred:** * Experience in utilization management /case management , critical care, or patient… more
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