- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical… more
- Elevance Health (Richmond, VA)
- …integration, and ensures essential face-to-face onboarding and skill development._ The ** Medical Management Clinician Sr** is responsible for ensuring ... that require the training and skill of a registered nurse . Acts as a resource for more junior Clinicians....efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine … more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- …and proper utilization of resources and care coordination. Responsibilities The Utilization Management ( UM ) Consultant Registered Nurse (RN) demonstrates ... quality management program area activities for the Medical Center and all off-site locations. The UM...month). VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases,… more
- Integra Partners (Troy, MI)
- The Utilization Management ( UM ) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures ... manager for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse Team Lead's responsibilities include but are… more
- Integra Partners (Troy, MI)
- … UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: ... will play a key role in collaborating with our Medical Director to perform benefit and medical ...+ Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- Summary The Miami VA medical Center is looking for recruit for Registered Nurse - Utilization Management / Float who is responsible and accountable for all ... for the UM microsystem that impacts operations or resources. The proficient UM nurse demonstrates critical thinking with efficiency and accuracy in assessing… more
- Corewell Health (Grand Rapids, MI)
- …nursing and or case management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life Support (BLS) ... Friday (4 hours), mostly remote, occasional on-site About the Department: RN UM - Supporting the insurance coordination functions for the Helen DeVos Children's… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy +… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... of services and care. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...required turnaround times. * Prepares and presents cases to Medical Director (MD) for medical director oversight… more
- Saint Francis Health System (Tulsa, OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of related experience in… more
- CVS Health (Austin, TX)
- …Social Worker (LCSW) preferred. + Requisition Job Description **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote and ... shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical...turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not… more
- Elevance Health (Indianapolis, IN)
- …accommodation is granted as required by law. ** Must be an Indiana resident ** The ** Medical Management Nurse ** is responsible for review of the most complex ... whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do...Director on particularly peculiar or complex cases as the nurse deems appropriate. + May make recommendations on alternate… 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 ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We... Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners… more
- University of Miami (Miami, FL)
- … Medical Training Lab at the Gordon Center is currently seeking a full time Nurse Educator - Medical Simulation and Education Lab to work in Miami, FL. The ... Nurse Educator provides clinical education to nursing and patient..., and critical thinking skills development. + Collaborates with medical providers, patient care staff, and unit management… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the CMHS. ... care standards for appropriate utilization of services. Perform utilization management /review for medical necessity for specialty referrals...within the last four (4) years as a registered nurse in utilization management . + One (1)… more
- CVS Health (Lansing, MI)
- …Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective ... high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where...computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM… more
- Evolent (Boston, MA)
- …of direct clinical patient care + Minimum of one year of experience with medical management activities in a managed care environment + Schedule: Monday-Friday, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- ERP International (Luke AFB, AZ)
- …ERP International is seeking a full time **Registered Nurse - Case Management ** in support of the56th Medical Group at Luke AFB, AZ ... CM software, and databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with social… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE ( Medical Specialty Segment Float Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations and communities ... opportunity employer. **Job Detail** **Job Opening ID** 271451 **Working Title** REGISTERED NURSE ( Medical Specialty Segment Float **Job Title** REGISTERED … more