- CVS Health (Columbus, OH)
- …state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): - ... schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant , you will utilize clinical skills… more
- CVS Health (Carson City, NV)
- …100% participation during 8:30am-5pm EST Monday-Friday As a UM Nurse Consultant you will work in a clinical telephone queue working with providers to ... additional information for prior authorization reviews. + This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the… more
- CVS Health (Helena, MT)
- …care. + 5 years demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted ... the first 3 weeks of training / 8:30am-5pm EST, Monday-Friday.** Work in clinical telephone queue working with providers to secure additional information for prior… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under...Reviewer RN II, under the purview the Utilization Management ( UM ) Department Leadership Team, is responsible for conducting and… more
- US Tech Solutions (RI)
- **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from ... clinical records or systems to apply appropriate ...MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE… more
- CVS Health (Hartford, CT)
- …of residence. **Position Summary** Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical ... requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. This position… more
- Kepro (ND)
- … Nurse (RN) Clinical Reviewer to join our growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review of medical ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- ERP International (Corpus Christi, TX)
- …review, discharge planning, continued stay reviews, and appeal reviews. * Serve as consultant to all disciplines regarding UM issues. Provide nursing expertise ... management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, UM software, databases for community… more
- ERP International (Camp Pendleton, CA)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position supporting **Branch Health Clinic Port Hueneme, CA** in ... such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.… more
- University of Miami (Miami, FL)
- …Accountabilities (For Non-exempt Employees Include Percent of Effort): Meets requirements of Clinical Trials Chemotherapy Nurse 50% 1. Works closely with the ... Cancer Center Sign-on Bonus: $25,000 T he Pediatric Chemotherapy Nurse will be a professional registered nurse ...health care, social services as needed. 15. Acts as consultant to clinical staff unfamiliar with pediatric… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... 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… more
- Alameda Health System (Oakland, CA)
- …to new equipment and/or techniques. + Review cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff ... based on critical timelines. + Develops and provides statistical UM information and reports to appropriate committees and in...Perform all other duties as assigned. + Performs daily clinical rounds and monthly audit of charts on care… more
- Alameda Health System (Oakland, CA)
- …to new equipment and/or techniques. -Reviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff ... of tracking variances based on critical timelines. -Develops and provides statistical UM information and reports to appropriate committees and in conjunction with… more
- University of Michigan (Ann Arbor, MI)
- …In addition, the ED PA coordinates emergent and urgent care with consultant services, recommends follow-up care, facilitates referrals to various internal and ... in Physician Assistant Studies + Demonstrated ability to manage multiple clinical tasks efficiently and effectively. + Demonstrated excellent organizational /problem… more