- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... and promotes the efficient and effective use of patient services. The Utilization Review Team's role in data collection, analysis and summarization supports the… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …rules, and regulations, clinical practice guidelines, and quality issues related to utilization management with application for appeals and denials management ... of employee health documents and reports. The manager is a registered professional nurse manager who is responsible for conducting inpatient Care Management ; and… more
- Tact Staff (Lansing, MI)
- …-BLS -Certification in Case Management -Experience in acute care case management , discharge planning, utilization management , performance improvement and ... 12 hoursEmployment Type: Travel8:30am-5pm 2 YEARS EXPERIENCE IN CASE MANAGEMENT , FIRST TIME TRAVELERS ACCEPTED WEEKENDS: 3 weekends per...Travel with Tact. Be Adventurous - Becoming a travel nurse is not only a professional adventure, but a… more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Case Management - Day (Temporary) Location: WellSpan Health, York, PA Schedule: Full Time Sign-On Bonus Eligible ... effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening… more
- CVS Health (Raleigh, NC)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... 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 (Harrisburg, PA)
- …Consultant role is fully remote and employee can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... coordinate, document and communicate all aspects of the utilization /benefit management program. You would be responsible for ensuring the member is receiving the… more
- CVS Health (Harrisburg, PA)
- …role is 100% remote and the candidate can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant...document and communicate all aspects of the utilization /benefit management program. You would be responsible… more
- CVS Health (Columbus, OH)
- …to work the following schedule: Monday-Friday 8:00am-4:30pm EST. Position Summary As a Utilization Management Nurse Consultant, you will utilize clinical ... and time management skills required - Experience in healthcare utilization management , critical care, emergency department, or case managementEducation… 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 ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 Position ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 ... any time with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced based… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... any time with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level determination approvals… more
- CVS Health (Austin, TX)
- …are Monday-Friday 9a-6p in time zone of residence. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience ... Qualifications + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...(twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience… more
- CVS Health (Raleigh, NC)
- …care more personal, convenient and affordable. Position Summary Precertification (Infertility): Utilization Management Nurse Consultant + Utilizes clinical ... needs + MS Office suites experience Preferred Qualifications + Precertification/ Utilization Management experience preferred + Infertility experience preferred… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse Job Description In this role, you will be responsible for reviewing requests for service authorizations to assist with ... and appropriate length of stay. Hard Skills + Active nurse licensure in the state of FL + Knowledge...in the state of FL + Knowledge of case management and UR concepts + Utilization review… more
- CVS Health (Austin, TX)
- …make health care more personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical ... Qualifications + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...(twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience… more
- Actalent (Des Moines, IA)
- Remote Utilization Management Nurse Description: Will provide service and support to members and health care providers- including pre-service reviews, out of ... medical criteria (InterQual) and benefit information Provide consultation and responses to utilization management requests May complete medical reviews any apply… more
- Insight Global (Philadelphia, PA)
- …A Healthcare Insurance company local to Philadelphia PA is looking to hire a Utilization Management Nurse (RN) to their delegation oversight & assessment ... PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or medicare/medicaid Experience/knowledge… more
