- CVS Health (Little Rock, AR)
- …operation and work schedules will include weekends, holidays, and evening hours As a Utilization Management Nurse Consultant , you will utilize clinical ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...to 7pm in time zone of work being supported. Utilization management is a 24/7 operation. Work… more
- CVS Health (Harrisburg, PA)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical experience in acute… more
- CVS Health (Austin, TX)
- …to work Monday through Friday, 9:00am to 7:00pm EST with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include ... holidays and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + Experience using… more
- CVS Health (Austin, TX)
- …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 zone.… more
- CVS Health (Jefferson City, MO)
- …+ 1+ years of MS Office suite experience **Preferred Qualifications** + Precertification/ Utilization Management experience + Preference for nurses in Pacific ... external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+...+ 3+ years of acute experience as a Registered Nurse + Must have active current and unrestricted RN… more
- CVS Health (Springfield, IL)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (Columbus, OH)
- …day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- PruittHealth (Columbia, SC)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required… more
- US Tech Solutions (RI)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. **Skills:** + MUST HAVE… more
- Lincoln Financial (Honolulu, HI)
- …Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible ... for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- CVS Health (Raleigh, NC)
- …9:00 PM EST approximately quarterly **Job Descriptions** The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and ... Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits… more
- CVS Health (Annapolis, MD)
- …Skilled Nursing (SNF) and Assisted Living (ALF) facilities. The Clinical Nurse Specialist/Infusion Educator for LTC (Long Term Care) will work collaboratively ... of the work week are considered office days to plan visits. The Clinical Nurse Specialist/Infusion Educator LTC is responsible for the below, most of which must be… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for...external committees as delegated or assigned. Serves as a consultant to other departments or organizations as needed. Responsible… more
- Access Dubuque (Dubuque, IA)
- …degree nursing program.** **Active and current license for Registered Nurse ** **Active and current International Board-Certified Lactation Consultant ... Lactation Consultant - Birth Center **MercyOne** 1 Positions ID:...health and wellness, particularly as it relates to breastfeeding management and early parenting issues.** **Helps breastfeeding women and… more
- McLaren Health Care (Lansing, MI)
- …the Patient Care Coordinator or Patient Care Manager, the Certified Lactation Consultant independently provides consultations to management for routine and ... or Practical Nurse by State of Michigan. * Certified Lactation Consultant (IBCLC) by the International Board of Lactation Consultant Examiners. * American… more
- MyFlorida (Orlando, FL)
- …Bachelor's Degree in any other discipline with at least 6 months of direct case management experience or a Florida Licensed Registered Nurse (RN) with 1-year of ... HUMAN SERVICES PROGRAM CONSULTANT II - 64006362 Date: Jun 4, 2025...(CBO's). Incumbent reports directly to the Supervisor of Case Management . Staff will establish and maintain a caseload of… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary The Patient Flow Utilization Management / Utilization Review Consultant RN functions with advanced knowledge and skills to provide clinical ... with a collaborative, inter-disciplinary practice setting. Responsibilities The Patient Flow Utilization Management / Utilization Review Consultant RN… more
- Highmark Health (Richmond, VA)
- … **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a ... in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant (PA) **Preferred** +… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- Summary The Registered Nurse (Integrated Care Management ) within the Office of Integrated Veteran Care (IVC) functions as an advisor, administrator, educator, ... consultant , and mentor who possesses a wide range of...Veteran healthcare Providing guidance and oversight of national program management to ensure proper resource utilization . Providing… more
- The Arora Group (Bethesda, MD)
- …Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty ... case-managed patients, throughout the continuum of care. + Conduct training in nurse case management for professional and paraprofessionals personnel, within the… more