- CVS Health (Phoenix, AZ)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. Gathers clinical information and ... the state of Arizona or Compact RN licensure Preferred Qualifications: + Utilization management experience preferred. + Acute care setting experience preferred… more
- Humana (Jackson, MS)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work... Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge,… more
- CVS Health (Austin, TX)
- …more personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience and ... EST zone (twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience + MedCompass Education… more
- CVS Health (Raleigh, NC)
- …the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant...to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical … more
- CVS Health (Columbus, OH)
- …employee can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote… more
- CVS Health (Columbus, OH)
- …any state. No travel is required. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- CVS Health (Austin, TX)
- …and employee can live in any state.As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... to make health care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...the state of Massachusetts required** + 3+ years **combined** clinical and utilization management experience… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Job Summary: Our Utilization Management Appeals Nurse -… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- McLaren Health Care (Detroit, MI)
- …with an acute care hospital** _Preferred:_ + Experience in utilization management /case management , critical care, clinical documentation, or patient ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement… more
- CVS Health (Plantation, FL)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical experience and skills ... (not all encompassing): -Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization , facilitates safe… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...Nursing Experience Required: At least 5 years of varied clinical experience in an acute hospital setting. At least… more
- CVS Health (Baton Rouge, LA)
- …Qualifications + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + 5+ years ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical...of equipment experience including phone, computer, and clinical documentation systems + A Registered Nurse … more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level...within managed care setting. + 3+ years experience in clinical nurse setting preferred. + TPA Experience… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- …Hospital (CVH (https://portal.ct.gov/DMHAS/CVH/Agency-Files/CVH Home-Page) ) + UNIT: ASSD Utilization Management Unit (Administrative Support Services Division) ... Utilization Review Nurse Coordinator (40 Hour)...Regulatory Requirements and private insurance as it relates to utilization review/ management and quality of care. +… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote ... 4:30pm Eastern Standard Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process to… more
- CVS Health (Columbus, OH)
- …and deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote ... pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to… more
- CVS Health (Trenton, NJ)
- …to make health care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote ... can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills...external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+… more
- CVS Health (Springfield, IL)
- …- 3+ years of clinical experience - Managed Care experience - Utilization management experience Education Associates degree required BSN preferred Pay Range ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...Qualifications - 3+ years of experience as a Registered Nurse - Must possess 1+ years of clinical… more