- Moses/Weitzman Health System (Meriden, CT)
- …licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or ... health care activities as agreed, eg school based clinic consultant , SNF care. Administrative Maintains board certification/licensure. Attends continuing education… more
- CVS Health (Carson City, NV)
- …full-time Utilization Management (UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to ... reviewing written clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote. ... As a Utilization Nurse Consultant , you will utilize clinical skills...to coordinate, document and communicate all aspects of the utilization /benefit management program and our plan sponsor(s).… more
- CVS Health (Atlanta, GA)
- …do it all with heart, each and every day. **Position Summary** Medicare Predetermination Utilization Management Nurse Consultant position: _Utilization ... with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience +… more
- CVS Health (Phoenix, AZ)
- …the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- CVS Health (Woonsocket, RI)
- …with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes clinical ... Time_ ). + Previous experience with prior authorization. + Previous experience with utilization management . + Previous experience in an acute care setting. +… more
- CVS Health (Topeka, KS)
- …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 zones… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- CVS Health (Springfield, IL)
- …and on the phone collecting and reviewing clinical information from providers. Utilization Management nurses use specific criteria to authorize inpatient ... paced environment NICU experience 3+ years **Preferred Qualifications** Previous Utilization Management experience Spine Experience **Education** Associates… more
- CVS Health (Columbus, OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... Summary** The Appeals Nurse Consultant plays a key role in...by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN must be… more
- CVS Health (Oklahoma City, OK)
- …health setting required. + Strong knowledge of clinical practice guidelines and utilization management . **Required** **Qualifications** : + Unrestricted OK state ... your clinical skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You'll apply critical thinking and… more
- CVS Health (Richmond, VA)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Elevance Health (Cincinnati, OH)
- **Wellness Nurse Consultant ** **Sign on Bonus: $5000** **Field:** This field-based role enables associates to primarily operate in the field, traveling to client ... and together we will drive the future of health care. The **Wellness Nurse Consultant ** position is responsible for developing and recommending customized,… 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
- CVS Health (Austin, TX)
- …in managed care, clinical, or health care related field. - 1 year of project management experience. - Registered Nurse (RN) license in the state of their ... in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. - Provides training and… more
- CVS Health (Springfield, IL)
- …in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. - Provides training and ... with diverse cultural dynamics of clinical staff and patients. - Registered Nurse (RN) required. **Preferred Qualifications** - Master's degree in healthcare related… more
- CVS Health (Hartford, CT)
- …**Preferred Qualifications** * Appeals Experience * Managed Care Experience * Utilization review experience * Proficiency with computer skills including navigating ... all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… 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
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Lactation Support Consultant position functions at the Proficient level according to Benner's model of clinical practice and is responsible ... breast feeding support under the general supervision of the Nurse Director. In addition to functioning as a staff... Director, Managers and Charge Nurses, the Lactation Support Consultant position is responsible for the quality of patient… more
