- Molina Healthcare (Norfolk, MA)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support...with a MA RN licensure. Candidates with UM Medical Review background and experience using… more
- CVS Health (Providence, RI)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote...UM specialty teams as needed, ensuring continuity of care and operational support. + Participate in occasional on-call… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in...expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases… more
- Highmark Health (Providence, RI)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more