- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- Summary The Jesse Brown VA Medical Center has a full-time Registered Nurse - Utilization Management position available for current, permanent employees of ... used while maintaining quality of care. Responsibilities The Registered Nurse (RN) - Utilization Management ...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … 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
- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...license, with no disciplinary action + 3+ years of prior clinical experience in an acute care hospital setting… more
- Veterans Affairs, Veterans Health Administration (St. Louis, MO)
- …St. Louis Health Care System (VASTLHCS), St. Louis, Missouri. The Registered Nurse Case Manager ( Utilization Management ) demonstrates leadership, experience, ... and creative approaches in providing complex patient management in delivering and improving holistic care through collaborative...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- CVS Health (Raleigh, NC)
- …schedules may include weekends, holidays, and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed ... health care more personal, convenient and affordable. **Position Summary** ** Utilization Management is a 24/7 operation and...Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN… more
- CVS Health (Helena, MT)
- …broadband service. **Preferred Qualifications** + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- Martin's Point Health Care (Portland, ME)
- … required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment required ... has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring… more
- Dartmouth Health (Lebanon, NH)
- Overview The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health system ... the option to be Fully Remote! These are just a few highlights of being a nurse at Dartmouth Hitchcock Medical Center and Clinics in New Hampshire. * We have loan… more
- R1 RCM (Pittsburgh, PA)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Nurse ** **Location: Hospital Client located in ... vary and some flexibility may be offered** As our ** Utilization Review Nurse ** , you will help...have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in… more
- Katmai (Usaf Academy, CO)
- …Bachelor of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… 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
- CVS Health (New Albany, OH)
- …Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically ... assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Independent Health (Buffalo, NY)
- …**Essential Accountabilities** + Provide high quality, professional utilization management services: (medical necessity review for Prior Authorization, ... benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to...review.) + Prompt, courteous, and error free in performing utilization management functions. + Available to answer… more
- CVS Health (Tallahassee, FL)
- …affordable. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may ... in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and...(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prior experience working… more
- CVS Health (Columbus, OH)
- …listening and computer use **Required Qualifications** + 1+ year varied Utilization Management experience within an inpatient/Outpatient setting, concurrent ... review or prior authorization. + 5+ years of variety clinical experience...with 100% participation during 8:30am-5pm Monday-Friday. + A Registered Nurse that must hold an unrestricted license in their… 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
- The Cigna Group (Bloomfield, CT)
- …Requirements include, but not limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to ... Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate… more
- Intermountain Health (Murray, UT)
- …evaluation, and innovative management of Select Health's Health Services care management and utilization management programs. Programs include but are ... platform products to both target and scale operations for utilization management , care management (eg...and maintain a clinical specialty license such as Registered Nurse , LCSW, Nurse Practitioner, Physician's Assistant, Physical… more
- Centene Corporation (Atlanta, GA)
- …key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization, ... or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred. Prior authorization preferred.… more
- WellSpan Health (York, PA)
- …regulatory requirement satisfaction, and staff engagement. + Provide oversight of utilization management , denials and Prior Authorization activities ... 5 years In leadership experience. Required + 3 years Utilization Management Experience. Preferred Licenses: + Licensed Registered Nurse Preferred Knowledge,… more