- CVS Health (Harrisburg, PA)
- …and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and ... unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours -Public speaking ability and preparing educational material **Preferred Qualifications** - 2+… more
- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... it all with heart, each and every day. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote and the candidate can live… more
- CVS Health (Columbus, OH)
- …a 24/7 operation and work schedule may include weekends, holidays, and evening hours._ ** UM Nurse Consultant ** Fully Remote- WFH **Schedule** - Mon-Fri ... 10:30AM-7PM with alternate weekends and holidays **Position Summary:** UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process… more
- CVS Health (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity of care and… more
- CVS Health (Hartford, CT)
- …with internal/external clinician support as required. This position may support UM , MPO, Coding, or Behavioral Health appeals. **Required Qualifications** * Must ... have active and unrestricted RN licensure in state of residence * 3+ years clinical experience **Preferred Qualifications** * Appeals Experience * Managed Care Experience * Utilization review experience * Proficiency with computer skills including navigating… more
- US Tech Solutions (RI)
- …+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization. **Education:** + RN with current unrestricted state licensure **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide… more
- University of Michigan (Ann Arbor, MI)
- CLINICAL CARE COORDINATOR- Lactation Consultant (Von Voigtlander Womens Hospital (VVWH) Apply Now **Job Summary** The Lactation Consultant will provide expert ... staffed by a diverse group of professionals, including Certified Nurse Midwives, Obstetricians, Family Practice Physicians, Maternal-Fetal Medicine Specialists,… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical insight ... delivery of the product, interacting with customer end users and managers. The Consultant will be responsible for ensuring that the complexity of our AI technology… more
- Veterans Affairs, Veterans Health Administration (Prescott, AZ)
- …are not limited to: The Utilization Management Coordinator (UMC) is a registered professional nurse who serves as a consultant to the facility for evaluating and ... VA Health Care System is looking for a Registered Nurse - Utilization Management to join the Quality &...care and services using standardized criteria. The Utilization Management ( UM ) Program, a key component of VHA's quality management… more
- ERP International (Yuma, AZ)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position at the Camp Pendleton **Branch Health Clinic** in ... and databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with social work case management. *… more
- University of Miami (Miami, FL)
- …(https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . CORE JOB SUMMARY The Registered Nurse 2 delivers patient-family centered care in a ... quality, safety, and service while ensuring population-specific patient care. The Registered Nurse 2 oversees nurses and allied health staff in their daily practice.… more
- University of Miami (Miami, FL)
- …a system that elevates any abnormal results (non - critical values) to the nurse who in turn will contact the physician accordingly 5. Ens ures that patients ... patient/family teaching using available resources and tools. 12. Acts as consultant to clinical staff in assisting with unfamiliar procedures/treatments. 13.… more
- LA Care Health Plan (Los Angeles, CA)
- …required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM ... overall performance metrics. The Supervisor ensures all functions of the UM department are operating in accordance with the organization's mission, values… more
- University of Southern California (Alhambra, CA)
- …individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific ... the status and processing of requests received from ambulatory care management nurse . 8. Assesses ongoing discharge planning needs and documents is computer system… more
- CVS Health (Richmond, VA)
- …physical and behavioral health clinical issues as they relate to medical management ( UM , CM, DM) provider and system of care issues, behavioral health and human ... services system issues + Supports and encourages CM and UM staff to function as interdisciplinary team, with requisite range and depth of subject matter expertise to… more
- Bassett Healthcare (Cooperstown, NY)
- …p ositive results + Works collaboratively with unit staff (charge nurse , staff nurse ) unit manager, and support team ( UM , MSW, SW, etc) to progress each ... deployment of resources and develops plans to optimize ROI + Serves as a consultant , coordinator and educator for the care coordination team related to issues of… more