- 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 , ... attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for...events throughout the year + Role specific - full remote work week ProgenyHealth positively recruits people from diverse… more
- University of Virginia (Charlottesville, VA)
- Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management ... UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission… more
- CVS Health (Raleigh, NC)
- …care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state. ... the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate,… more
- CVS Health (Columbus, OH)
- …convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the … more
- CVS Health (Harrisburg, PA)
- …convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document… more
- CVS Health (Harrisburg, PA)
- …convenient and affordable. Position Summary: This Utilization Management (UM) Nurse 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 … more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... 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)
- …personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+ years of… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/Hybrid (2 ... days Remote , 3 days in Office) **Position Summary** : The Registered Professional Utilization Management Lead is responsible for upholding and developing… 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 (Bismarck, ND)
- …shift up to 8:00pm EST zone (twice per month) Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience and ... 1+ year(s) of Med/Surg experience Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience + MedCompass… more
- AdventHealth (Altamonte Springs, FL)
- …strategies including concurrent payer communications to . resolve status disputes. . The Utilization Management Nurse is accountable for a designated patient ... **Shift** : Full-time; Monday - Friday **Job Location** : Remote **The role you'll contribute:** . The role of...**The role you'll contribute:** . The role of the Utilization Management (UM) Registered Nurse … more
- Humana (Oklahoma City, OK)
- …documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are ... committed to removing barriers to helping people achieve their best health. The Utilization Management (UM) Nurse 2 uses clinical nursing skills to support… more
- Virtua Health (Pennsauken, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... Locations: Job Information: Schedule: Monday - Friday 8:00am - 4:30. This is a remote position but would require going into the office in Pennsauken on an… more
- Gentiva (Mooresville, NC)
- …care for everyone, so we offer ongoing professional training, lower nurse -to-patient ratios, and comprehensive benefits for eligible employees. Here, you'll join ... a lasting difference in people's lives every day. **Overview** The ** Utilization Manager** plans, coordinates, implements, and finalizes projects according to the… more
- Centene Corporation (Columbia, SC)
- …benefits including a fresh perspective on workplace flexibility. + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management… more
- Centene Corporation (Sacramento, CA)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Humana (Columbus, OH)
- …us put health first** Full-Time Remote , Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health ... of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from medical… more
- Actalent (Santa Barbara, CA)
- …Health Services' operational units. These units include, but are not limited to, the Utilization Management , Case Management , Enhanced Care Management , ... Actalent is looking for a fully remote RN Case Manager to work Monday-Friday 8am-5pm,...unit. Depending on unit assignment, the HPNC may perform utilization management activities, which may include telephonic… more
- Sedgwick Government Solutions (Orlando, FL)
- … Nurse Case Manager ( Remote ) 2024-1342 Orlando, FL, USA Medical Case Management Full Time Description Nurse Case Manager (Home Based) - Specialty Unit ** ... Would you like to be part of a highly skilled team of home-based ** Nurse Case Manager (NCM)s** providing telephonic case management , focused on supporting… more