- CVS Health (Lansing, MI)
- …- Friday, 8:00am - 5:00pm EST Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring ... a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria...licensure in state of residence + 3+ years of clinical experience + Must be wiling and able to… more
- CVS Health (Trenton, NJ)
- …travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in a ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- CVS Health (Columbus, OH)
- …EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process ... solutions to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee… more
- CVS Health (Trenton, NJ)
- …is fully remote and employee can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- CVS Health (Raleigh, NC)
- …state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... There is no travel expected with this position. This UM Nurse Consultant position is...the membership of plan sponsor. As a Utilization Management Nurse Consultant , you will utilize clinical… more
- CVS Health (Columbus, OH)
- …state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is...can live in any state. As a Utilization Management Nurse Consultant , you will utilize clinical… more
- CVS Health (Columbus, OH)
- …state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): - ... personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is...state. No travel is required. As a Utilization Management Nurse Consultant , you will utilize clinical… more
- CVS Health (Austin, TX)
- …state regulated turn-around times. This includes reviewing written clinical records.The UM Nurse Consultant job duties include (not all encompassing):- ... personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is...employee can live in any state.As a Utilization Management Nurse Consultant , you will utilize clinical… more
- CVS Health (Hartford, CT)
- …health care more personal, convenient and affordable. Position Summary + Utilizes clinical experience and skills in a collaborative process to assess, plan, ... to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- Kepro (Richmond, VA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer RN to join our growing team. Job Summary: Our ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing; Master's Degree; Certified ... to identify areas of risk and act as a consultant to the facility based ICM leaders to develop...Years Acute Care Case Management experience. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred… more
- CVS Health (Phoenix, AZ)
- …and able to work on Arizona time zone. No weekends, holidays are required. The UM Clinical Consultant utilizes clinical skills to coordinate, document ... coordination and administration of the utilization/benefit management function. Gathers clinical information and applies the appropriate medical necessity criteria/guideline,… more
- CVS Health (Columbus, OH)
- …health care more personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee ... 4:30pm Eastern Standard Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process… more
- CVS Health (Plantation, FL)
- …Monday-Friday; 10:00 AM- 6:30 PM EST No nights, no weekends, and no holidays. The UM Nurse Consultant job duties include (not all encompassing): -Reviews ... Compact RN License or license in multiple states + UM Nurse Consultant experience +... clinical setting with diverse cultural dynamics of clinical staff and patients. Education Registered Nurse :… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary Duals UM Nurse Consultant Pennsylvania - Institutional Special Needs Plan ... ISNP) Scheduled : Monday through Friday 9:30am to 6:00pm EST zone Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual contributor ... and escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against… more
- CVS Health (Phoenix, AZ)
- …coverage (URAC and Client Requirements). + Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and ... time is spent at a desk and on the telephone collecting & reviewing clinical information from providers. Required Qualifications + 1+ year: Oncology and Transplant … more
- CVS Health (Columbus, OH)
- …Work from home anywhere in the USA. No travel is required. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- CVS Health (Columbus, OH)
- …our Duals Program and is going to be auditing against the use of clinical criteria, policy procedures, and for compliance purposes. Schedule is Monday - Friday ... 8:00am - 5:00pm. Will have to maintain clinical review skills through he annual use of IRR....work with leadership for continual process improvement within Duals UM Program. Required Qualifications + RN with current unrestricted… more
- Bassett Healthcare (Cooperstown, NY)
- … as needed. Identifies need for patient to receive IM letter; collaborates with UM Nurse as needed. Assists Clinical Documentation Specialist in engaging ... Employer 2022! What you'll do The Emergency Department Registered Nurse Clinical Case Manager (Unit C3 RN)...status and level of care matches order. Collaborates with UM Nurse to assure that all payor… more