- CVS Health (Harrisburg, PA)
- …Consultant role is 100% remote and the candidate can live in Pennsylvania. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... coordinate, document and communicate all aspects of the utilization /benefit management program. You would be responsible for ensuring the member is receiving the… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Austin, TX)
- …care more personal, convenient and affordable. Position Summary Precertification (Infertility): Utilization Management Nurse Consultant + Utilizes clinical ... needs + MS Office suites experience Preferred Qualifications + Precertification/ Utilization Management experience preferred + Infertility experience preferred… more
- Adecco US, Inc. (Dallas, TX)
- **Join Our Team as a Utilization Management Nurse !** **Experience Required:** + Five years inpatient clinical nursing experience in an acute care hospital ... setting + Minimum of two years Utilization Management acute care setting experience + Minimum of one year drafting and submitting reconsiderations and appeals to… more
- CVS Health (Columbus, OH)
- …and deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + 3+ years of… more
- CVS Health (Springfield, IL)
- …to make health care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+ years of… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He… more
- AdventHealth (Tampa, FL)
- …Association as a Primary Stroke Center. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical ... acute care clinical nursing experience required. . Minimum two years Utilization Management experience, or equivalent professional experience. This facility… more
- Cedars-Sinai (Los Angeles, CA)
- …Repetitive Motions, Eye/Hand/Foot Coordination **Req ID** : 1262 **Working Title** : Registered Nurse - Utilization Management Utilization Review - ... Per Diem 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category** : Patient Services **Job… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management /Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to… more
- CVS Health (Plantation, FL)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical experience and skills in a ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Minimal 3-5+ years… more
- CVS Health (Columbus, OH)
- …a work 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 aspects of the utilization /benefit management program. You would be responsible...and is detail oriented and highly organized. The UM Nurse Consultant reviews services to assure medical necessity, applies… more
- ProgenyHealth (Elk Grove Village, IL)
- ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization , ... and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of stay and a facilitator for… more
- CVS Health (Columbus, OH)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...Qualifications - 3+ years of experience as a Registered Nurse - Must possess 1+ years of clinical experience… more
- CVS Health (Trenton, NJ)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...Required Qualifications- 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN… more
- CVS Health (Jefferson City, MO)
- …and external constituents in the coordination and administration of the utilization /benefit management function.- Typical office working environment with ... weekend position Required Qualifications - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN licensure in state of… more
- CVS Health (Harrisburg, PA)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...Qualifications - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN… more
- CVS Health (Trenton, NJ)
- …work occasional holiday and weekends depending on business needs Preferred Qualifications - Utilization management experience - Managed care experience - Must be ... services. Maintains accurate and complete documentation to meet risk management , regulatory, and accreditation requirements. Promotes communication, both internally… more
- CVS Health (Columbus, OH)
- …in New Albany OH, Chandler AZ or High Point NC Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... coordinating all case management activities with members to evaluate the medical needs...Services strategies, policies and programs are comprised of network management and clinical coverage policies.What is A1A?Aetna One Advocate… more