- CVS Health (Harrisburg, PA)
- …live in any state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote… 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 ... business needs - Holiday rotation required Preferred Qualifications: - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care -… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with on site staff, physicians, providers,… 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
- Humana (Pierre, SD)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… 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 -...requirements, including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies to physician reviewers for… 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 ... reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. .… more
- Cedars-Sinai (Los Angeles, CA)
- …Repetitive Motions, Eye/Hand/Foot Coordination **Req ID** : 1261 **Working Title** : Registered Nurse - Utilization Management - 8 Hour Days **Department** ... **Job Description** **Job Summary: Key Job Responsibilities** The Utilization Review Case Manager validates the...: Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category**… 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 (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...Must have MS Office suites experience Preferred Qualifications - Utilization Review experience preferred, but not required.… more
- ProgenyHealth (Elk Grove Village, IL)
- …that is physician sensitive and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of ... ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization ,… 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...care innovators.Fundamentals:Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… 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 ... Remote, 3 days in Office) **Position Summary** : The Registered Professional Utilization Management Lead is responsible for upholding and developing standardized… more
- Adecco US, Inc. (Dallas, TX)
- …a very close knit team and being a team player is a must! The Utilization Management Nurse will provide precertification of inpatient hospitalizations and ... an acute care hospital setting, minimum of 2 years Utilization Management / Review in an acute...of inpatient hospitalizations and extended courses of outpatient. The nurse will use clinical judgement, utlization management ,… more
- UCLA Health (Los Angeles, CA)
- …leader with: * Current CA LVN licensure required * Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- Veterans Affairs, Veterans Health Administration (Roseburg, OR)
- …outcomes and External Peer Review Program (EPRP) metrics. Acts as the Utilization Management nurse for the inpatient acute psychiatric unit. Serves ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Contact ###@va.gov. Responsibilities Roseburg...on older adults and mental health. Acts as the Utilization Management (UM) nurse for… more
- Fallon Health (Worcester, MA)
- …a Registered Nurse in a clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care payer preferred. + One year ... necessity, benefit eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review of the referred… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Humana (Indianapolis, IN)
- …and help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health ... Individual shift to be discussed during the interview. The Utilization Management Behavioral Health Nurse ...Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation… more
- Amergis (Porterville, CA)
- …in written and oral formats of communication. Position Details: + Job title: Senior Utilization Management Nurse Coordinator + Job Function: Nursing + ... Amergis HealthcareStaffing is looking to hire a Senior Utilization Management Registered NurseCoordinator in Porterville,...Department: Utilization Review + Location: Porterville, California + Type: Full Time… more