- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses;...in a direct patient care clinical setting. Must have utilization management , utilization review… more
- CVS Health (Harrisburg, PA)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with MS office applications such… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Management NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization ... activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines + Medicaid… more
- CVS Health (Austin, TX)
- …operation. Work schedules may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant you will be responsible for ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...work Monday through Friday 8:00am to 5pm CST + Utilization management is a 24/7 operation. Work… more
- Humana (Tallahassee, FL)
- …put health first** Humana Healthy Horizons in Florida is seeking a Utilization Management Nurse (Front End Review ) who will utilize clinical nursing ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 's work assignments are varied… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Management Nurse in Houston, TX! This role is hybrid with a mix of work from home ... 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Management Nurse :** . Responsible...for Case Management and institutes a care management plan . Provides concurrent review on… more
- McLaren Health Care (Pontiac, MI)
- …requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or ... **Position Summary:** Responsible for Utilization and Care Management services to...on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …facilitates interdisciplinary team collaboration, from admission through discharge. He/she will review medical records and accurately document UM reviews in NUMI ... following the VACO UM process and the InterQual review process. He/she will facilitate and coordinate admissions to...and performance measures. He/she will utilize emergency and bed management software, along with UM data, to manage admission… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage ... with occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse (RN)...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to...(Outlined in Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education:… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse , Revenue Integrity & Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health ... Forbes as a Best Employer. Position Summary: The RN Utilization Management I will perform utilization...payors as applicable. + Completes daily work lists for utilization review meeting the time frames set… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- AdventHealth (Altamonte Springs, FL)
- …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse ...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,… more
- AmeriHealth Caritas (Dover, DE)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... times, quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and organization with the ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- McLaren Health Care (Lansing, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... equivalent through the Military Training network (MTN) _Preferred:_ + Experience in utilization management /case management , critical care, or patient… more
- Intermountain Health (Murray, UT)
- …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... regarding authorizations, approved treatment plan and length of stay. **Skills** + Utilization Management + Clinical Expertise + Independent and autonomous +… more