- CVS Health (Baton Rouge, LA)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is knowledgeable ... external constituents in the coordination and administration of the utilization /benefit management function. **Required** **Qualifications** + Licensed… more
- CVS Health (Columbus, OH)
- …EST.** **Position Summary** As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical experience and… more
- CVS Health (Columbus, OH)
- …holidays, and evening hours_ As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... aspects of the utilization /benefit management program. + Utilizes ...clinical experience in acute or post-acute setting - Utilization management is a 24/7 operation. Work… more
- CVS Health (Helena, MT)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills ... broadband service. **Preferred Qualifications** + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent… more
- CVS Health (Carson City, NV)
- …working in a high volume clinical call center environment + 1+ year Utilization Management experience + 1+ years Managed Care experience + Remote work ... participation during 8:30am-5pm EST Monday-Friday As a UM Nurse Consultant you will work in a clinical ...to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical… more
- CVS Health (New Albany, OH)
- …overall wellness. Services strategies, policies and programs are comprised of network management and clinical coverage policies. **What is A1A?** Aetna One ... training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically assessing,… more
- CVS Health (Tallahassee, FL)
- …and unrestricted RN licensure in Florida + Must reside in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work ... **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and...and evening hours. + Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for… more
- Defense Health Agency (Fort Drum, NY)
- … data, and educating staff on referral management .** Apply for this Job Online (https://careers-civilianmedicaljobs.icims.com/jobs/8299/nurse- consultant ... management review and analysis, including: patient demographic data; clinical variances; cost avoidance relating to medical procedures and ancillary services;… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse...to develop and execute mitigation efforts. Serves as a consultant to the organization's Compliance team on an ad… more
- Kepro (CA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary ... As a Utilization Clinical Reviewer, you'll harness your expertise...+ Determine approval or initiate referrals to the physician consultant , processing decisions and providing detailed denials as needed.… more
- Cedars-Sinai (Los Angeles, CA)
- …evidence-based care. + Interpret analyses of outcomes of interventions, including clinical , patient-centered, utilization , and financial outcomes and identify ... this position will also lead best practices in project management for our largest initiatives. + Analyze current operational...\#LI-Hybrid **Req ID** : 3029 **Working Title** : Senior Consultant , Clinical Transformation & Value - Hybrid… more
- Banner Health (Phoenix, AZ)
- …culture of trust and respect. In your role as a Banner Health **Senior Clinical Engineering Consultant ,** you will work in a fast-paced, and rewarding ... the cost of equipment ownership for the organization. 3. Provides direct project management support and clinical engineering expertise to major projects. Provide… more
- Guidehouse (Chicago, IL)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and health plan executives help healthcare organizations undertake cross-continuum clinical transformation efforts to generate sustained improvements in care access,… more
- Guidehouse (Chicago, IL)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and health plan executives help healthcare organizations undertake cross-continuum clinical transformation efforts to generate sustained improvements in care access,… more
- Guidehouse (Mclean, VA)
- …+ Clinical credential (RN, MD, DO) is also acceptable + Experience with utilization management programs + Health Plan / Insurer Experience + Health System ... **Job Family** **:** Management Consulting **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + **Research:** Thoroughly… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for...external committees as delegated or assigned. Serves as a consultant to other departments or organizations as needed. Responsible… more
- Huron Consulting Group (Chicago, IL)
- …other stakeholders to ensure the effective use of Cerner, enhance clinical and administrative workflows, and improve patient care outcomes. **Qualifications** ... **Required:** + Experienced in using Cerner's Capacity Management solution to optimize patient flows and bed tracking,...to optimize patient flows and bed tracking, analyze resource utilization and looking at ways to improve operational efficiency… more
- ERP International (Corpus Christi, TX)
- …executive staff, newcomers, as appropriate. * Participate in all phases of the Utilization Management Program (UMP) and ensure that the UMP meets established ... Utilization Management (UM) standards of care. Assist...planning, implementation, coordination, and monitoring. * Collect and analyze clinical utilization data to identify information on… more
- Children's Hospital & Research Center Oakland (Oakland, CA)
- …Benioff Children's Hospital Oakland (UCSF BCH-Oakland). The purpose of the Lean management system is improvement in clinical and operational performance ... system and a linked learning system that connects senior management work to the work of the frontlines. The...Consultant will lead improvement activities that transcend quality, clinical and operational dimensions to support achievement of the… more
- BD (Becton, Dickinson and Company) (Franklin Lakes, NJ)
- **Job Description Summary** The Specimen Management Consultant , SMC (NYC, Long Island, Westchester, Orange County), will sell existing and new BD IDS consumable ... sales calls to introduce novel solutions to customers through clinical insights, quality products and studies/tools to customers. +...and market expertise and educate the market on proper utilization and acceptance of BD product portfolio. + Keep… more