- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... coverage while working remotely. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced… more
- CVS Health (Phoenix, AZ)
- …information is necessary and will involve computer system data entry, data management , and reporting. + Review criteria-based prior authorizations following ... **Position Summary** You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Aetna Specialty Medical … more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …(VAGLAHS) is seeking to hire experienced Registered Nurses to work in our Utilization Management (UM) Program. Incumbents are expected to perform assessing, ... following: Demonstrates ability to perform a wide range of Utilization Management /Quality Management /Performance Improvement (UM/QM/PI)...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the ... present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual + Milliman… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , 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 a key role in… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman… more
- CVS Health (Denver, CO)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +… more
- CVS Health (Carson City, NV)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum...+ At least 1 year of Utilization Management experience in concurrent review or prior … more
- CVS Health (Little Rock, AR)
- …of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient ... constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state… more
- CVS Health (Austin, TX)
- …with Microsoft Office applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization or Utilization Management experience + ... internal and external constituents in the coordination and administration of the utilization /benefit management function. **_Please note: This is a full time… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- …Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and ... Summary The Revenue Utilization Review (RUR) nurse is under...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- US Tech Solutions (Chicago, IL)
- …an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- Intermountain Health (Murray, UT)
- …regarding authorizations, approved treatment plan and length of stay. **Skills** + Utilization Management + Clinical Expertise + Independent and autonomous + ... in care management /navigation or closely related field including: Utilization Management , discharge planning, managed care, health promotion, health… more
- Premier Health (Dayton, OH)
- … Prior job title or occupational experience: Case management , utilization review, clinical nurse Prior specific functional responsibilities: N/A ... with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management , utilization of information systems and regulatory… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available. Monday-Friday, 8:00AM-4:30PM. + **Facility:** St. Agnes ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- US Tech Solutions (May, OK)
- …experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- Elevance Health (San Antonio, TX)
- …affordability, and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior ... support. **Build the Possibilities. Make an extraordinary impact.** The ** Utilization Management Representative II - Prior...caller. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more