- The University of Vermont Health Network (Colchester, VT)
- POSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended ... Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting with the coordination of the Utilization Management… more
- Fallon Health (Worcester, MA)
- …more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. The UM Nurse uses a multidisciplinary approach to organize, coordinate, monitor, ... complex medical and psychosocial needs of FH members and their families. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient… more
- CVS Health (Columbus, OH)
- …in the US Work hours: 8:30am-5:00pm EST, Monday-Friday. This position is for a UM nurse consultant who will be joining our reconsideration team. A ... reconsideration nurse will review any additional information submitted within the...management function. Required Qualifications + 1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent… more
- CVS Health (Carson City, NV)
- …required 3 weeks training required 100% participation during 8:30am-5pm EST Monday-Friday As a UM Nurse Consultant you will work in a clinical telephone queue ... working with providers to secure additional information for prior authorization reviews. -This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. -Utilizes clinical… more
- YesCare Corp (Brentwood, TN)
- …management program development, implementation, evaluation and reporting. + Work with other UM inpatient and outpatient nurse reviewers to assure proper ... and other proprietary company/client systems. + Certificates and Licenses: Registered Nurse (RN) active license + Language Ability: Strong verbal, written… more
- Ventura County (Ventura, CA)
- Medical Management Nurse Senior- UM , CM/DM, &/or QA (Updated) Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4280743) Apply Medical ... Management Nurse Senior- UM , CM/DM, &/or QA (Updated) Salary $103,388.98 - $123,616.69 Annually Location Ventura and may require travel throughout Ventura County,… more
- CVS Health (Salem, OR)
- …will occasionally be required.Required Qualifications 1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent ... ability to make thorough, independent decisions using clinical judgement. A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- CVS Health (Jefferson City, MO)
- …verbal and written Required Qualifications + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure in state of ... residence + Must possess 1+ years of clinical experience in acute or post-acute setting + Must be available to work Monday through Friday from 8 AM to 5 PM in resident time zone + Some weekends and holidays will be required Preferred Qualifications + 3+ years… more
- CVS Health (Montgomery, AL)
- …This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our ... purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors (TM) support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming… more
- Molina Healthcare (Bronx, NY)
- …the severity of illness and the site of service. **We are seeking a Registered Nurse with UM and Inpatient Review experience. The Care Review Clinician must be ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- Bassett Healthcare (Cooperstown, NY)
- …admission order and validates status and level of care matches order. Collaborates with UM Nurse to assure that all payor and status requirements are aligned ... Nurse on discharge needs/barriers for all patients; initiates intervention by UM Nurse as needed. Identifies need for patient to receive IM letter;… more
- CVS Health (Raleigh, NC)
- …1 holiday per year). There is no travel expected with this position. This UM Nurse Consultant position is part of Aetna's Commercial Care Management division ... turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): -Reviews services… more
- CVS Health (Columbus, OH)
- …9:30am-6:00 pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative ... to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can live in any… more
- CVS Health (Columbus, OH)
- …state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): -Reviews ... health care more personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can… more
- CVS Health (Harrisburg, PA)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): - ... health care more personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can… more
- CVS Health (Plantation, FL)
- …10:00 AM- 6:30 PM EST No nights, no weekends, and no holidays. The UM Nurse Consultant job duties include (not all encompassing): -Reviews services to ... highly preferred + Compact RN License or license in multiple states + UM Nurse Consultant experience + Experience with overseas access to care + Working… more
- CVS Health (Harrisburg, PA)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): - ... health care more personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is 100% remote and the candidate… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary Duals UM Nurse Consultant Pennsylvania - Institutional Special Needs Plan (PA ... - Utilization Review experience preferred - Managed care experience - UM /CM/MCG Certification - Med Compass Experience Education Associates Degree required BSN… more
- CVS Health (Columbus, OH)
- …and motivated team environment and is detail oriented and highly organized. The UM Nurse Consultant reviews services to assure medical necessity, applies ... at home position and employee can live in any state. As a Utilization Nurse Consultant you will utilize clinical skills to coordinate, document and communicate all… more
- Molina Healthcare (Bronx, NY)
- …the severity of illness and the site of service. **We are seeking a Registered Nurse with previous UM and** **inpatient experience along with knowledge of the ... NYS Medicaid guidelines** . **Previous leadership experience highly preferred. The candidate must be able to work in a high-volume environment.** **_Further details to be discussed during our interview process._** **Remote position in New York.** **Work… more
