- Glens Falls Hospital (Glens Falls, NY)
- …- Case Management * **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for Full-Time & Part-Time Positions, ... ACM) within 1 year. * Two years of acute care , utilization management , or payer...or payer experience preferred. *Licenses, Certifications, Registrations:* * Registered Nurse (RN) in New York State *Skills and Abilities:*… more
- Fallon Health (Worcester, MA)
- …Nurse in a clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care payer preferred. + One year experience ... Management Department, Government Services Clinical Programs, Fallon Clinic Care Coordination + Department and/or other community services according to… more
- Actalent (San Diego, CA)
- …status and patient classification. Skills: case management , acute care , registered nurse , utilization management , Care management , Health ... 9PM - 7AM Top Skills Details: case management ,acute care ,registered nurse , utilization management Additional Skills & Qualifications: Registered… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist...of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...Management (CM). Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid… more
- McLaren Health Care (Detroit, MI)
- …timeliness, appropriateness and completeness as pertains to the utilization management process including level of care , medical necessity, and third-party ... as needed. _Required:_ + State licensure as a registered nurse (RN) + Bachelor's degree in nursing from accredited...**Three years of recent nursing or utilization management experience with an acute care hospital**… more
- Ventura County (Ventura, CA)
- …needs; + Coordinates the interdisciplinary approach to providing continuity of care , including Utilization management , Transfer coordination, Discharge ... Diem Registered Nurse III - Hospital Case Management / Utilization Review Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4396275) Apply Per… more
- ERP International (Tinker AFB, OK)
- …Practice Managers, Health Care Integrators, Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management , Referral Management , TRICARE ... may include but are not limited to** : Provides Utilization Management activities and functions by using...:Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of… 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, ... $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created...Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- 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
- Martin's Point Health Care (Portland, ME)
- …BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment required + ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...transitions of care to lower/higher levels of care , makes referrals for care management… 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 in Office) **Position Summary** : The Registered Professional Utilization Management Lead is responsible for upholding...UMRN Lead is responsible for LOS and Level of Care to provide effective and efficient health care… 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 -...Appeals Team, contribute to quality initiatives, and champion continuous care for our members. From meticulous case reviews to… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …EM Key Solutions is seeking Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the Medical Maintenance Team at Eglin ... Practice Managers, Health Care Integrators, Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management , Referral Management , TRICARE… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …EM Key Solutions is seeking a Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the Medical Maintenance Team at Eglin ... Practice Managers, Health Care Integrators, Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management , Referral Management , TRICARE… 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 (Columbus, OH)
- …solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + 3+ years of… 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
- Cedars-Sinai (Los Angeles, CA)
- …Repetitive Motions, Eye/Hand/Foot Coordination **Req ID** : 1262 **Working Title** : Registered Nurse - Utilization Management Utilization Review - ... placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR...Per Diem 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… 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 ... Building a brand new, six story surgical and patient care tower which will ensure state of the art... clinical nursing experience required. . Minimum two years Utilization Management experience, or equivalent professional experience.… 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 and ... internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+ years of… more