- Novo Nordisk Inc. (Plainsboro, NJ)
- …most diverse and collaborative groups within the organization. From health -care-provider interactions and developing and implementing regulatory strategies with the ... a difference? The Position Position provides field coaching, mentorship and management to the field-based Medical Liaisons, and develops and implements strategies:… more
- Novo Nordisk Inc. (San Antonio, TX)
- …to deliver on this aspiration. The team is comprised of both our home office strategy and marketing execution teams and our field based teams focusing ... in helping people living with chronic disease achieve greater health outcomes. If you are passionate about being a...resources to expand the breadth and depth of appropriate utilization Novo Nordisks products, consistent with label and company… more
- Humana (Richmond, VA)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Manager Utilization Management Nursing utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and… more
- Sharp HealthCare (San Diego, CA)
- …including ICU or intermediate care units, Medical-Surgical Nursing, and/or Home Health . + 1 Year Utilization Management /Concurrent review experience. + ... practices. **What You Will Do** Provide leadership and direct supervision for Utilization Management (UM) department staff. Accountable for results of the… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Humana (Columbus, OH)
- …and assists corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs. + Collects and analyzes ... Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health ) who...this may be rare, it will happen._ **Work at Home Internet Statement** To ensure Home or… more
- CVS Health (Raleigh, NC)
- …solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee ... team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize...clinical experience as an RN (all clinical areas considered: Home Health , Med/Surg, Telemetry, ICU, NICU, Long… more
- Dignity Health (Rancho Cordova, CA)
- …Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines and ... UM experience with Charge/Lead/Supervisory/ Management experience in Utilization Management department preferred. - Experience working with health plan… more
- Intermountain Health (Las Vegas, NV)
- …+ Five years in a professional setting such as hospital, clinic, or home health environment. + Effective communication and interpersonal skills. + Demonstrated ... knowledge of CMS guidelines, health plan criteria, MCG criteria, and state, local, or...criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case… more
- Centene Corporation (Tallahassee, FL)
- …POSITION IS REMOTE/WORK FROM HOME , NO TRAVEL, SUPPORTING A MARKET PLACE UTILIZATION MANAGEMENT TEAM.** **APPLICANTS MUST BE ABLE TO WORK EITHER CENTRAL TIME ... Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- CVS Health (Frankfort, KY)
- …3+ years clinical practice experience, eg, hospital setting, alternative care setting such as home health or ambulatory care required + This is a remote ... Bring your heart to CVS Health . Every one of us at CVS ...external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills… more
- Sanford Health (Sioux Falls, SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... **Careers With Purpose** **Sanford Health is one of the largest and fastest-growing...potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ID**: ... for UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration with all departments to… more
- CVS Health (Trenton, NJ)
- …(Med Surg, hospital setting, ICU, ER, Long term care, SNF skilled nursing facility, home health ) - Work across multiple IT and platform systems - Required ... Bring your heart to CVS Health . Every one of us at CVS ...per business needs Preferred Qualifications - Prior authorization & utilization management experience - Outpatient Clinical experience… more
- Corewell Health (Southfield, MI)
- …to obtain authorization numbers for payment. + Provides clerical support for Utilization Management ; sorting faxes and mail, obtaining authorization numbers, ... + Utilizes electronic medical record work queues that support Utilization Management functions. + Answers incoming calls...or email. + Other duties as assigned. How Corewell Health cares for you + Comprehensive benefits package to… more
- Kaleida Health (Buffalo, NY)
- …inpatient, outpatient, and the home health continuum, as well as utilization management and case management . Incumbent must maintain their knowledge ... Qualifications:** BS - Bachelor of Science in Nursing or health related profession (ie social work) required. MA -...related profession (ie social work) preferred. 3-5 years in Utilization , Discharge Planning, and Case Management required.… more
- CVS Health (Lansing, MI)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. For more information on our benefit ... Bring your heart to CVS Health . Every one of us at CVS ...convenient and affordable. Position Summary Fully remote Work from home anywhere in the US. Working hours will be… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Trinity Health (Hartford, CT)
- …that care efficiently to control costs. **What you will do:** + As a ** Utilization Management Registered Nurse RN** you will conduct prospective, concurrent and ... Shift **Description:** **Position Purpose** At **Saint Francis Hospital** the Case Management Department helps patients coordinate and navigate through their … more
