- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Centene Corporation (Jefferson City, MO)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job...+ Clinical review + Utilization review + Utilization management + ... Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse ( RN )** for a full-time position supporting the 2d Medical ... in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of clinical… 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 ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN , to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- CVS Health (Columbus, OH)
- …+ Must reside in ET zone + 3+ years of clinical experience as a Registered Nurse in a hospital setting including Medical/Surgical, Emergency room, Critical Care, ... with a late shift rotation 10:30am to 7pm EST. Utilization management is a 24/7 operation. Work...weekends and holidays and evening rotations. **Preferred Qualifications** + Utilization review experience + Medicare experience +… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Healthfirst (SC)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review , ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- AmeriHealth Caritas (Newark, DE)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will...in Nursing (BSN) preferred. + An active compact state Registered Nurse ( RN ) license in… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key...care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care ... to provide the best quality care. The Team The RN Utilization Management Reviewer...against a license must be disclosed and reviewed + Registered nurses only, bachelor's degree in nursing (BSN) preferred… more
- CVS Health (Charleston, WV)
- … function. Required Qualifications: + Licensed independent Behavioral Health clinician or a Registered Nurse ( RN ) with unrestricted state license with ... do it all with heart, each and every day. ** Utilization Management Clinical Consultant** **Remote - West...Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with unrestricted… 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
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... weeks on camera training required 100% participation during 8:30am-5pm Monday-Friday. * A Registered Nurse that must hold an unrestricted license in their state… more
- AmeriHealth Caritas (Washington, DC)
- **Role Overview** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity,...setting **Licensure** + Current driver's license required + A Registered Nurse ( RN ) license in… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... Trials, Oncology, and/or elective surgical cases preferred. Essential Qualifications * Current licensed Registered Nurse ( RN ) or Licensed Practical Nurse … more