- 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...requirements, including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies to physician reviewers for… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Universal Health Services (Temecula, CA)
- …Healthcare Regional office in Temecula, CA is seeking Two (2) LVN Full-Time Central Utilization Review Nurses who will be responsible for carrying out ... correct payer source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers, external regulatory… more
- Humana (Jackson, MS)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management: + Review cases using clinical knowledge, communication skills, and ... a 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
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Sacramento, CA)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Humana (Columbus, OH)
- …+ Supervises utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior ... health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to support… more
- Centene Corporation (Raleigh, NC)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical 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… more
- Centene Corporation (Oklahoma City, OK)
- …on workplace flexibility. **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. ... utilization management. + Manages behavioral health (BH) utilization review clinicians and ensures compliance with...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Humana (Columbus, OH)
- …caring community and help us put health first** The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical ... the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to pre-certification,… more
- Dignity Health (Rancho Cordova, CA)
- **Overview** This position is hybrid in-office and work from home.** Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit ... to maintaining excellence in care and service. **Responsibilities** This position is hybrid in-office and work from home.** **Position Summary:** Under the guidance… more
- Elevance Health (Meridian, ID)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50… more
- Centene Corporation (Cheyenne, WY)
- …levels of care and facilities + Partners with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners ... and concurrent review findings + Provides education to providers on utilization processes to ensure high quality appropriate care to members + Partners with… more
- Centene Corporation (Tucson, AZ)
- …flexibility. **Must reside in Arizona!!** **Centene is currently seeking a remote Clinical Review Nurse -Concurrent Review to join their Arizona Medicaid ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- CareFirst (Baltimore, MD)
- …**Knowledge, Skills and Abilities (KSAs)** + Knowledge of NCQA requirements of utilization review , Case Management standards and guidelines, appeal rights and ... Strategic Plan through direction of the Clinical Medical Claims Review , Medical Underwriting, Medical Policy, Clinical Appeals and Analysis...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Centene Corporation (Oklahoma City, OK)
- …or RN licensure. **Position Purpose:** Drafts correspondence letters based on review outcomes in accordance with National Committee for Quality Assurance (NCQA) ... management to identify and implement opportunities for improvement. + Performs clinical review of outcomes including creating and editing denial letters with the… more
- Centene Corporation (Oklahoma City, OK)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Bassett Healthcare (Cooperstown, NY)
- …care to surgical patients across 12 operating rooms and one hybrid operating room, with accessible state-of-the-art equipment! Annually, we navigate approximately ... specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Operating Room / Perioperative Services unit… more
- WellSpan Health (Mount Gretna, PA)
- Care Nurse Coordinator RN - Child Adolescent Inpatient - Days / Evenings Location: WellSpan Philhaven, Mount Gretna, PA Schedule: PRN/Per Diem Sign-On Bonus Eligible ... Remote/ Hybrid Regular Apply Now See More Events PRN as...treatment progress. + Participates in daily communication with primary nurse , communicating any clinical concerns and assist in developing… more
- CareFirst (Baltimore, MD)
- …Licensure. **Experience:** 3 years Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...Qualifications:** 5 years Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… more