- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... with diverse cultural dynamics of clinical staff and patients. Registered Nurse ( RN ) required. Licensed...+ Requisition Job Description **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is… more
- CVS Health (Columbus, OH)
- …in the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Medical Review, you'll play a ... Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- …of resources and care coordination. Responsibilities The Utilization Management ( UM ) Consultant Registered Nurse ( RN ) demonstrates leadership, ... RN reports to the UM Manager RN . The UM RN demonstrates...level degree in Nursing may have opportunity to become registered as a nurse with a state… 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 ... as per physician orders and within the scope of RN licensure 7. Renders dire ct patient care by...teaching using available resources and tools. 12. Acts as consultant to clinical staff in assisting with unfamiliar procedures/treatments.… more
- CVS Health (Lansing, MI)
- …for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant , where you'll apply clinical judgment and evidence-based criteria ... + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more
- CVS Health (Lansing, MI)
- …heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated **Appeals Nurse Consultant ** to join our remote team. In this role, you will ... with internal/external clinician support as required. + This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals. + This is… 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 ... of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization. **Education:** + RN with current unrestricted state licensure **About US Tech Solutions:** US Tech… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical insight ... delivery of the product, interacting with customer end users and managers. The Consultant will be responsible for ensuring that the complexity of our AI technology… more
- University of Southern California (Alhambra, CA)
- …InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic ... needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in...and processing of requests received from ambulatory care management nurse . 8. Assesses ongoing discharge planning needs and documents… more