- CVS Health (Phoenix, AZ)
- …for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Key Responsibilities** + Apply critical thinking and ... times may vary based on business needs) **Location:** 100% Remote (US only) American Health Holding, Inc. (AHH), a...a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- WellSpan Health (York, PA)
- …effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening ... as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required **\#LI- REMOTE… 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
- Tufts Medicine (Burlington, MA)
- … Review and Discharge Planning including implementation and annual review of the Utilization Management Plan and assisting with the coordination of the ... additional hours on weekends/off hours as needed. **Location:** Primarily remote . May require occasional travel to local facilities including...Utilization Management Committee. The … more
- AmeriHealth Caritas (Washington, DC)
- …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...Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse (RN) license in the District of Columbia in… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management ...involving shadowing a team member on-site on Tuesdays and remote shadowing via Teams. Pay and Benefits The pay… 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, ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization + Experience ... needed or until the member's 21st birthday + The nurse will maintain current knowledge and understanding of the...pertaining to Pediatric Shift Care services **Work Arrangement;** + Remote + Qualified candidates will be able to work… more
- Centene Corporation (Austin, TX)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... ensure adherence to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related… more
- Humana (Tallahassee, FL)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...the appropriate courses of action. This position is considered remote /work at home and may require 5% travel to… more
- AdventHealth (Orlando, FL)
- …water, creating a holistic environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical ... years acute care clinical nursing experience required. + Minimum two years Utilization Management experience, or equivalent professional experience. + Excellent… more
- Humana (Lincoln, NE)
- **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 (Frankfort, KY)
- …KENTUCKY - SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… more
- Atrius Health (Watertown, MA)
- …**Clinical Programs* **Title:** *Licensed Practical Nurse (LPN) Anticoagulation Management Service - Remote * **Location:** *Watertown MA* **Requisition ID:** ... care system in the country. *SUMMARY* Under the direction and supervision of a Nurse Leader or designee, this licensed practical nurse provides direct patient… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license… more
- Ochsner Health (New Orleans, LA)
- …Louisiana Registered Nurse (RN) License Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization ... to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in...of patient care as an RN. Experience in Case Management , Utilization Review and/or Discharge Planning .either… more
- Centene Corporation (Austin, TX)
- …review care services related to mental health and substance abuse is preferred. + Utilization Review/ Utilization management with behavioral health cases + ... million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization...if you hold a LPC, LCSW, or LMFT. Registered Nurse can hold Texas State Licensure and/or Compact State… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- Integra Partners (Troy, MI)
- …individual situation or the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the ... is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a salaried, 40+ hour per week position… more
- Molina Healthcare (Los Angeles, CA)
- **JOB DESCRIPTION** **Job Summary** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
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