- The University of Vermont Health Network (Berlin, VT)
- …Central Vermont Medical Center in Berlin, VT.POSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate ... including psychiatry; affirming compliance with CMS' Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting… more
- Integrated Resources, Inc (New York, NY)
- …the quality of life for the MetroPlusHealth members. . Coordinate with Utilization Management ( UM ) department on concurrent and retrospective review. . Follow up ... Using the assessments and interview done by the Assessment Nurse , the Care Manager identifies the risk factors, strengths,...category to the member. . As part of Care Management team, develops a formal care plan for all… 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 (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... function. Required Qualifications + 1 year of varied UM (utilization management ) experience within an inpatient/outpatient… 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
- CVS Health (Hartford, CT)
- …constituents in the coordination and administration of the utilization/benefit management function. + Typical office working environment with productivity and ... Required Qualifications- 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… 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
- 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)
- …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
- Robert Half Office Team (Los Angeles, CA)
- …and approve medical referrals that meet specific criteria as a Utilization Management Nurse Specialist RN * Ensure timely and exact referral determinations ... Description We are seeking a UM Review Nurse to ensure the...occasionally, appeals * Function as a department guide for medical service requests/referral management and procedures *… more
- Kepro (Richmond, VA)
- …a vital partner for health solutions in the public sector. Acentra seeks a UM Reviewer & Appeals Coordinator RN/LCSW (Remote within Virginia) to join our growing ... role - you will utilize clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical… 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
- 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 ... Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review, and/or other utilization management … 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
- Veterans Affairs, Veterans Health Administration (Vancouver, WA)
- …charm, this is the place to call home. The VISN 20 Utilization Management Nurse Specialist collaborates with interdisciplinary team members, including other ... ) Programs in VISN 20. The VISN 20 Utilization Management Nurse Specialist works closely and collaboratively...high degree of leadership, motivation, self-direction, and initiative in UM /BMS/activities. The UM Nurse Specialist… 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
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...area of service decisions and organizational determinations. The Utilization Management ( UM ) Reviewer is responsible for day-to-day… more
