- Premera Blue Cross (Mountlake Terrace, WA)
- …account managers, producers, and clients about pharmacy programs and benefits. + Provide clinical drug utilization management , formulary management , and ... serve pharmacy students and/or residents as a preceptor, introducing them to drug utilization management , care management activities, product review, and… more
- Moses/Weitzman Health System (Meriden, CT)
- …component meeting client's health care needs. Participates with Community Health Center management in developing and achieving optimal clinical performance and ... licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or… more
- CVS Health (Woonsocket, RI)
- …all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (Oklahoma City, OK)
- …a psychiatric or behavioral health setting required. + Strong knowledge of clinical practice guidelines and utilization management . **Required** ... clinical skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You'll apply critical thinking and… more
- CVS Health (Richmond, VA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Carson City, NV)
- …(UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited to) + Reviews...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Columbus, OH)
- …resolving clinical complaints and appeals by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN must be ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our...3+ years Utilization Management or Utilization Review experience. + 3+ years clinical … more
- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote. As a ... Utilization Nurse Consultant , you will utilize clinical skills to...to coordinate, document and communicate all aspects of the utilization /benefit management program and our plan sponsor(s).… more
- CVS Health (Atlanta, GA)
- …all with heart, each and every day. **Position Summary** Medicare Predetermination Utilization Management Nurse Consultant position: _Utilization ... with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience +… more
- CVS Health (Topeka, KS)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in Central Time zones… more
- CVS Health (Phoenix, AZ)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- CVS Health (Springfield, IL)
- …time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Utilization Management nurses use specific criteria ... paced environment NICU experience 3+ years **Preferred Qualifications** Previous Utilization Management experience Spine Experience **Education** Associates… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications**… more
- Vitalief (New Brunswick, NJ)
- …and achieve sustainable growth. The Role We are seeking a highly experienced Clinical Research Operational Management Consultant to lead a short-term ... and accelerate breakthroughs that improve patient care. We bring deep clinical research expertise together with practical, results-driven consulting to help… more
- CareFirst (Baltimore, MD)
- …**Experience:** 5 years experience in business development, operational technology support, Utilization Management (UM) operations, Clinical Product ... role will focus specifically on optimizing end-to-end business processes within Utilization Management . **ESSENTIAL FUNCTIONS:** + Provide deep subject matter… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Cross and Blue Shield of Minnesota Position Title: Principal Provider Performance Clinical Consultant Location: Hybrid | Eagan, Minnesota Career Area: Strategic ... and leading consultative conversations with provider groups about opportunities to improve clinical and cost/ utilization trend. * Responsible for developing and… more
- BD (Becton, Dickinson and Company) (San Jose, CA)
- …This position reports to the Regional Business Manager and supports the Specimen Management business unit. This role observes current clinical practice and ... responsibilities will include:** + Fosters a continually evolving partnership between Specimen Management and our valued customers in a Clinical Process advisory… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and leading consultative conversations with provider groups about opportunities to improve clinical and cost/ utilization trend. * Responsible for developing and ... all lines of business. The role works in tandem with the Manager of Clinical Consultation, Pr Provider Performance Clinical Consultants, and the Medical Director… more
- Child Communication and Behavior Specialists (CA)
- …and culturally inclusive environment. The Position We are seeking a Remote BCBA Supervisor & Clinical Consultant to join our team. This role is 100% remote with ... individualized, high-quality ABA programs. Key Responsibilities + Provide hands-on clinical supervision using Behavioral Skills Training (BST). + Facilitate… more
- Highmark Health (Camp Hill, PA)
- …as the clinical subject matter expert for clinical , quality, care, utilization , high cost claim and population health management as the part of the ... markets. The incumbent is primarily accountable for the delivery of clinical analysis and strategies for Highmark customers, including healthcare consultants and… more
