- 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 ... including psychiatry; affirming compliance with CMS' Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting… 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… 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, ... psychosocial needs of FH members and their families. The UM Nurse is responsible for assuring the...requirements, and performs other responsibilities as assigned by department management team + Participates in weekly medical … more
- YesCare Corp (Brentwood, TN)
- … program development, implementation, evaluation and reporting. + Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment ... appropriate time. + Communicate and document any issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management . + Assist with… 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 ... to coordinate, document and communicate all aspects of the utilization/benefit management program. -Utilizes clinical experience and skills in a collaborative… more
- CVS Health (Salem, OR)
- …coverage will occasionally be required.Required Qualifications 1 year of varied UM (utilization management ) experience within an inpatient/outpatient setting, ... skills to coordinate, document and communicate all aspects of the utilization management program. The candidate will utilize clinical experience and skills in a… more
- Sharp HealthCare (San Diego, CA)
- …2 Years relevant experience in a medical setting (ie: office, hospital, SNF, medical clinic, etc). + California Licensed Vocational Nurse (LVN) - CA Board of ... **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing &...referral management system in OnBase, the document management system.Reviews for medical necessity and appropriateness… more
- Sharp HealthCare (San Diego, CA)
- …Degree; Associate's Degree in Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board ... (ICM) team the Transfer and Admissions Utilization Manager ( UM ) partners with the Centralized Patient Placement Center (CPPC)...the health care team as well as the respective medical groups to facilitate the utilization management … more
- Elevance Health (Chicago, IL)
- …payment as part of consideration for employment. **Director of Medical Mgmt, Post Acute Care UM ** + Job Family: MED > Licensed Nurse + Type: Full time + Date ... Operations organization is looking to hire a **Director of Medical Management .** This people leader will manage...clinical operations business inside a health plan or a UM /benefits management firm -Utilization management … more
- CVS Health (Montgomery, AL)
- …to coordinate, document and communicate all aspects of the utilization/benefit management program. -Utilizes clinical experience and skills in a collaborative ... constituents in the coordination and administration of the utilization/benefit management function. Required Qualifications3+ years of acute care clinical experience… more
- Molina Healthcare (Bronx, NY)
- …Care Review Clinician with Prior Authorization experience. Experience with Utilization Management ( UM ) is highly preferred. Additional experience with appeals, ... requests within required timelines. + Under the direction of a Registered Nurse , identifies appropriate benefits, eligibility and expected length of stay for… 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 ... Degree in Nursing **Preferred Experience** Recent hospital experience in ICU, Medical , or ER unit. ** UM Experience** **Preferred License, Certification,… more
- Kepro (Richmond, VA)
- …partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer (PRN, Remote within Virginia) with an active RN, LCSW, LPC, ... and/or LBA to join our growing team. Job Summary: Our Behavioral Health UM Clinical Reviewer (RN, LCSW,LPC, and/or LBA) will use clinical expertise to review … more
- Humana (Columbus, OH)
- …update training for UM nurses. + Develops programs to improve UM nurse competencies (critical thinking skills, interpreting criteria, communication with ... Training programs may include, but not be limited to, Pre-Certification, Care Management , Utilization Management , and/or Compliance. + Plans, coordinates, and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and ... UM RN 75 Vanderbilt Ave, Staten Island, NY...home to improve their quality of life. The Utilization Management nurse will assess and process all… more
- LifePoint Health (Las Cruces, NM)
- …protected by applicable federal, state or local law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** *RN Case Manager - UM - PRN* ... are appreciated for who you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum of care, including diagnostic,… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... UM Clinical Reviewer 5297 W Copans Rd, Margate,...their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization… more
- Sharp HealthCare (San Diego, CA)
- …and utilization management activities performed in a manner consistent with Medical Groups' policies and procedures. Assists in obtaining medical information ... **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing &...meet skilled level of care. Makes appropriate referral to Medical Groups' Care Management programs.Communicates with the… more
- LA Care Health Plan (Los Angeles, CA)
- …. Preferred: Managed Care experience performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, ... Utilization Management Nurse Specialist RN II Job...requests by Providers. Acts as a department resource for medical service requests /referral management and processes.… more
- The Arora Group (Bethesda, MD)
- …disposition of referrals, MEPERS, EOM reports, and actively participate in weekly/bi-weekly medical management conferences and report any updates to the staff ... MTF and IAW JC guidelines to include, the following: + Provide professional case management services at Walter Reed National Military Medical Center (WRNMMC) or… more
