- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management ... + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- CVS Health (Columbus, OH)
- …day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out of ... independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse ( RN ) with unrestricted...to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and… more
- The Cigna Group (Sacramento, CA)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and...Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical … more
- Intermountain Health (Murray, UT)
- …questions regarding authorizations, approved treatment plan and length of stay. **Skills** + Utilization Management + Clinical Expertise + Independent and ... in care management /navigation or closely related field including: Utilization Management , discharge planning, managed care, health promotion, health… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Management reports to the Director of Utilization Management * Oversees clinical ...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from accredited ... needs in EMR for continued communication with ICM UM RN and Care Management staff 7. Assesses..._Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management / clinical … more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management / clinical /or combination; 2 of ... clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … 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 ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Centene Corporation (Atlanta, GA)
- …We're looking for experienced nurses with a strong background in **appeals, denials, utilization management , clinical review, and claims** . **Preferred ... + Experience in appeals and denials + Background in utilization management and claims review If you're...- Licensed Vocational Nurse required or + RN - Registered Nurse -… more
- CVS Health (Carson City, NV)
- …**Must reside in the PST zone** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... **Required Qualifications** - 2 years of experience as a Registered Nurse in adult acute care/critical care... RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...education, and preventative interventions are maintained. Qualifications: + Active RN license, entry level RN welcome +… more
- Dignity Health (Bakersfield, CA)
- …will require Admin on-call on weekends/holidays.** **Position Summary:** The Supervisor of Utilization Management Inpatient Clinical will oversee clinical ... UM staff, ensuring they effectively perform utilization management (UM) reviews for inpatient cases. This role works...required. - Graduate of an accredited school of nursing: Registered Nursing. - Clear and current CA RN… more
- Tenet Healthcare (Detroit, MI)
- …underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements ... Registered Nurse Case Manager Contingent Days...for case management scope of services including: Utilization Management supporting medical necessity and denial… more
- UCLA Health (Los Angeles, CA)
- …self-directed individual with: * Bachelor's degree in health-related field, preferred * A Registered Nurse ( RN ) license or MD diploma (or equivalent) ... or equivalent of education and experience in case management , utilization management or prior clinical documentation review experience, required *… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- Summary The Utilization Management (UM) Registered Nurse ( RN ) is responsible and accountable for all elements of the nursing process when providing ... Responsibilities The Utilization Management (UM) Registered Nurse ( RN ) is responsible...levels on admission and continued stay criteria and best clinical documentation and utilization management … more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER: (Care Management - D....reduce barriers to discharge ** Utilization Review and Utilization Management ** + Conduct clinical ... Allscript + Identify opportunities for cost reduction and participate in appropriate utilization management venues + Conducts referrals and consultation with… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN ) supports daily coordination of care across healthcare continuum with the ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN...care related field required. Current registration as a Licensed Registered Professional Nurse in New York State.… more
- UPMC (Pittsburgh, PA)
- …1 year of health insurance experience required. + 1 year of experience in clinical , utilization management , home care, discharge planning, and/or case ... summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan...+ Certified Case Manager (CCM) + Driver's License + Registered Nurse ( RN ) + Act… more
- Trinity Health (Ann Arbor, MI)
- …**Description:** **POSITION PURPOSE** + The Utilization Review Specialist is a Registered Nurse that is responsible for facilitating collection of patient ... clinically relevant knowledge regarding patient population. + Licensure: Current Registered Nurse license in the State of Michigan ( RN ). **POSITION BENEFITS… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager to work the Directorate of Healthcare Operations ... be provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ):...Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical… more