- Northeast Georgia Health System, Inc (Gainesville, GA)
- …members as needed to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure patients ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia...patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team… more
- US Tech Solutions, Inc. (Atlanta, GA)
- Job Title: Care Management Associate Location: Remote WITHIN Arizona Duration: 9 months contract Job Description: . Support comprehensive coordination of medical ... and supporting the implementation of referrals to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare… more
- UnitedHealth Group (Worcester, MA)
- …in PCP and staff education presentations, care coordination meetings, case reviews, utilization management rounds and other department meetings as required or ... behavioral activation, motivational interviewing, etc.Present cases to regional Prescribers ( Nurse Practitioners and Psychiatrists)Perform case management and… 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 , ... 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
- 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
- Ascension Health (Southfield, MI)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review. + Review… 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 (Raleigh, NC)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… 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
- Children's Mercy Kansas City (Kansas City, MO)
- …Responsibilities Personnel management : + Directs team members in the delivery of utilization management and care management services. + Promotes a ... Partners with Revenue Cycle, Payor Relations, HIM and Risk Management in support of utilization management...One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire. RNs who… more
- CVS Health (Frankfort, KY)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to coordinate, ... document and communicate all aspects of the utilization /benefit management program. Required Qualifications : +...(LCSW, LPCC, LMFT , LPAT, LP) or a Registered Nurse (RN) with active current and unrestricted Kentucky state… more
- Molina Healthcare (Columbia, SC)
- …Health plan (Medicaid and Marketplace). Strong experience with appeals reviews and/or utilization management working on the manage care side. Excellent computer ... For this position we are seeking a (RN) Registered Nurse who must be licensed in the state you...Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports… more
- Sanford Health (SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… 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
- Elevance Health (Columbus, OH)
- …+ Ohio + Missouri + Kentucky + Florida **Description** ** Utilization Management Rep II** **Location: This is a remote opportunity. Candidates can ... you for payment as part of consideration for employment. ** Utilization Management Rep II** + Job Family:...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
