- CVS Health (Tallahassee, FL)
- …of the utilization/benefit management function. Required Qualifications Registered Nurse (RN) with psychiatric specialty, certification, or experience. Must ... which includes navigating multiple systems and keyboarding Education Registered Nurse (RN) with psychiatric specialty, certification, or experience; compact license… more
- CVS Health (Topeka, KS)
- …experience including phone, computer, and clinical documentation systems + A Registered Nurse that must hold an unrestricted license in the state of Kansas, ... with multi-state/compact privileges and be willing and able to be licensed in all non-compact states + Must be willing and able to work Monday through Friday, 8:00am to 5:00pm CST. + Must be willing and able to work weekend/holiday coverage rotation + Must… more
- CVS Health (Harrisburg, PA)
- …verbal and written Required Qualifications + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required + Must have active current and ... unrestricted RN licensure in state of residence + Must possess 1+ years of clinical experience in acute or post-acute setting + Must be available to work Monday through Friday from 8 AM to 5 PM in resident time zone; -Some weekends and holidays will be… more
- CVS Health (Lansing, MI)
- …This role is Telework anywhere! Schedule for this position is Monday - Friday, 8:00am - 5:00pm EST Applies critical thinking, evidenced based clinical criteria and ... Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.… more
- CVS Health (Raleigh, NC)
- …(typically 1 holiday per year). There is no travel expected with this position. This UM Nurse Consultant position is part of Aetna's Commercial Care ... regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): -Reviews… more
- CVS Health (Columbus, OH)
- …9:30am-6:00 pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a ... to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can live in… more
- CVS Health (Lansing, MI)
- … role is fully remote and employee can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process ... Experience Medicare/Medicaid populations - MCG experience - Managed care experience - UM Certification - MedCompass - 1+ year(s) of inpatient utilization experience… more
- CVS Health (Columbus, OH)
- …health care more personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee ... Eastern Standard Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process to assess,… more
- CVS Health (Raleigh, NC)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can live in… more
- CVS Health (Plantation, FL)
- …Monday-Friday; 10:00 AM- 6:30 PM EST No nights, no weekends, and no holidays. The UM Nurse Consultant job duties include (not all encompassing): -Reviews ... Spanish highly preferred + Compact RN License or license in multiple states + UM Nurse Consultant experience + Experience with overseas access to care +… more
- CVS Health (Lansing, MI)
- …Est time.) No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in a ... our benefit programs, please visithttps://jobs.cvshealth.com/employee-benefits (https://protect-usb.mimecast.com/s/HChtCEKL7mupo2P4Q84HN2Ovk?domain=jobs.cvshealth.com) Required Qualifications Registered Nurse in state of residence 3+ years of Nursing… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary Duals UM Nurse Consultant Pennsylvania - Institutional Special Needs Plan ... - Utilization Review experience preferred - Managed care experience - UM /CM/MCG Certification - Med Compass Experience Education Associates Degree required BSN… more
- Kepro (Richmond, VA)
- …for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer (part-time) to join our growing team. Job Summary: Our Behavioral ... for services. + Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the… more
- CVS Health (Phoenix, AZ)
- …to work on Arizona time zone. No weekends, holidays are required. The UM Clinical Consultant utilizes clinical skills to coordinate, document and communicate ... all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. Consults and lends expertise to… more
- CVS Health (Phoenix, AZ)
- …information from providers. Required Qualifications + 1+ year: Oncology and Transplant UM , concurrent review or prior authorization + 3+ years: acute clinical ... training required 100% participation during 8:30am-5pm Monday-Friday EST. + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- US Tech Solutions (RI)
- …+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization. **Education:** + RN with current unrestricted state licensure **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide… more
- CVS Health (Trenton, NJ)
- …Medicare/Medicaid - Managed care (MCO) experience - Med Compass experience - CM/ UM Certification Education Associates Degree required BSN preferred Pay Range The ... typical pay range for this role is: $30.39 - $65.66 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual contributor while collaborating ... + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria and accreditation and regulatory criteria… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN) Case Manager to work the Directorate of Healthcare Operations (DHO) at ... two-week period will be provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER (RN): The contracted RN shall provide the following services and… more
- Bassett Healthcare (Cooperstown, NY)
- …admission order and validates status and level of care matches order. Collaborates with UM Nurse to assure that all payor and status requirements are aligned ... align care team towards discharge goals. Serves as a consultant and educator with medical staff regarding status, placement,...on discharge needs/barriers for all patients; initiates intervention by UM Nurse as needed. Identifies need for… more