- Advocate Aurora Health (Oak Lawn, IL)
- …Operations, site leadership and other key stakeholders. Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for care ... organizes key ongoing education, serves as a supportive member of site UM Committees, and/or other site meetings as appropriate. Participates in multidisciplinary… more
- Wellstar Health System (Roswell, GA)
- …to assist upon discharge. b. Partners with the PAS, financial counselor, and/ or UM nurse to assess insurance and coverage requirements for all payers to ... an expert resource for complex patient and situations and serves as a consultant to the other care team members regarding patient's clinical, psychosocial and… more
- CVS Health (Richmond, VA)
- …do it all with heart, each and every day. **Position Summary** The Utilization Management ( UM ) Nurse Consultant is a remote, full-time role responsible for ... evaluating the medical necessity and appropriateness of healthcare services using evidence-based clinical criteria. This position involves conducting utilization reviews, collaborating with healthcare providers, and supporting care coordination to ensure… more
- CVS Health (Madison, WI)
- …extended periods of time, talking on the telephone, and typing on the computer. The UM Nurse 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. + Utilizes clinical… 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
- 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 (Phoenix, AZ)
- …Counselor (LPC) + Licensed Marriage and Family Therapist (LMFT) + Registered Nurse (RN) + Associate-level licenses may be considered based on relevant experience. ... + Knowledge of Behavioral Health Outpatient Services. + Utilization Management ( UM ) Experience. **Education** + Master's degree required for behavioral health… more
- University of Miami (Miami, FL)
- …this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . JOB DESCRIPTION UM Title: Senior Registered Nurse Supervisor's ... 2014. Job Summary (Purpose and Function): The Pain Management Nurse will be a professional registered nurse ...and variances to the plan of care. Documents in UM Care program intra-procedure assessment of patient condition. Planning… more
- ERP International (Yuma, AZ)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position at the Camp Pendleton **Branch Health Clinic** in ... and databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with social work case management. *… more
- University of Miami (Miami, FL)
- …a system that elevates any abnormal results (non - critical values) to the nurse who in turn will contact the physician accordingly 5. Ens ures that patients ... patient/family teaching using available resources and tools. 12. Acts as consultant to clinical staff in assisting with unfamiliar procedures/treatments. 13.… more
- University of Miami (Miami, FL)
- …Employees Include Percent of Effort): Meets requirements of Clinical Trials Chemotherapy Nurse 50% Works closely with the medical director and the pediatric nursing ... protocol and clinical practice standards. Provides documentation to the Research Nurse / Nurse Coordinators, and/or Research Staff/Data Managers. Meets study… more
- University of Miami (Miami, FL)
- …Percent of Effort): Meets requirements of Clinical Trials Senior Chemotherapy Nurse 30% Administers research study agents, standard chemotherapy and biotherapy ... clinical protocol and clinical practice standards. Provides documentation to the Research Nurse and/or Data Manager. Meets study timelines and objectives as defined… more
- LA Care Health Plan (Los Angeles, CA)
- …required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM ... overall performance metrics. The Supervisor ensures all functions of the UM department are operating in accordance with the organization's mission, values… more
