- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He… more
- 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
- 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
- Humana (Columbus, OH)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Dublin, OH)
- …caring community and help us put health first** Humana Healthy Horizons is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Carson City, NV)
- **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
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Baylor Scott & White Health (Dallas, TX)
- …meetings. + 3, 12 hour shifts. Saturday, Sunday, Monday. **JOB SUMMARY** The Utilization Review Registered Nurse (RN) provides a clinical review of cases ... **SCHEDULE:** + Hybrid -remote. You will work mostly remote and are...issues. + Knowledge and use of discharge planning, case management referral criteria, utilization review and levels… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... Position Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
- Universal Health Services (Temecula, CA)
- … Utilization Review Nurses who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs ... payer source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and… more
- Humana (Columbus, OH)
- …put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to ... behavioral health services and/or benefit administration determinations. The Manager, Utilization Management (Behavioral Health) applies a Person-Centered… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization management ... rotating schedule. (about 2 holidays per year) The Compliance Utilization Management Nurse 2 ensures...meetings **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided… more
- Centene Corporation (Tallahassee, FL)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Centene Corporation (Austin, TX)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (New York, NY)
- …state of NY. 5 years of nursing experience. 1 year experience in Utilization Management . Reliable transportation required.Mileage is reimbursed per our company ... and affordable. A Brief Overview This is a unique hybrid position that will support the an external provider...the an external provider team as a Float Registered Nurse . This position will help to help cover for… more
- Humana (Oklahoma City, OK)
- …documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are ... barriers to helping people achieve their best health. The Utilization Management (UM) Nurse 2...team **Work at Home Criteria** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided… more
- Dignity Health (Rancho Cordova, CA)
- …the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of ... **Overview** This position is hybrid in-office and work from home.** Dignity Health...Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management… more
- Houston Methodist (Houston, TX)
- + **Registered Nurse preferred** + **RN with general medicine preferred** + ** Hybrid position-Monday-Friday** + **Location: 8100 Greenbriar Houston, TX 77054** ... clinicians in a financially responsible manner. Under the direction of department management and in collaboration with key stakeholders, the Clinical Value Analysis… more
- Houston Methodist (Houston, TX)
- + Registered Nurse preferred + RN with general medicine preferred + Hybrid position-Monday-Friday JOB SUMMARY At Houston Methodist, the Senior Service Line ... clinicians in a financially responsible manner. Under the direction of department management and in collaboration with key stakeholders, the Clinical Value Analysis… more
- Elevance Health (Columbus, OH)
- **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more