- Monster (Alhambra, CA)
- Job Description: In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for ... out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group. Responsibilities include, but… more
- Dignity Health (Bakersfield, CA)
- …criteria used for decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider to validate ... denial notice for determination. - Escalates non-compliant cases to UM compliance and consistently reports on denial activities. -...LVN Program. - Clear and current CA Licensed Vocational Nurse (LVN). - Knowledge of nursing theory and ability… more
- AdventHealth (Daytona Beach, FL)
- …does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated ... 32117 **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical expertise by analyzing patient records… more
- University of Washington (Seattle, WA)
- …medical necessity and financial liability for patients all hospitalized patients. The UM Nurse communicates this information with the interdisciplinary team to ... procedures, and quality patient care for the duration of the hospitalization. The UM Nurse is responsible for maintaining the knowledge and skill set related to… more
- CVS Health (Lansing, MI)
- …may include weekends, holidays, and evening hours._ _Weekends: F/S/S/M 10 hour shifts_ ** UM Nurse Consultant** Fully Remote- WFH **Position Summary** UM ... Nurse Consultant Position Summary: UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Annapolis, MD)
- …high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. **Key Responsibilities** ... of a computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity… more
- CVS Health (Phoenix, AZ)
- …the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Oncology and Transplant, you'll play a ... + Minimum of 1 year of experience in Oncology and Transplant either in UM , concurrent review, or prior authorization + 3+ years of experience in Acute clinical… 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 vital ... Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and… more
- AdventHealth (Altamonte Springs, FL)
- …does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated ... **The role you will contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to… more
- AdventHealth (Daytona Beach, FL)
- …does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated ... you'll contribute:** The role of the Emergency Department Utilization Management ( UM ) Registered Nurse (RN) is to use clinical expertise by analyzing patient… 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
- Mount Sinai Health System (New York, NY)
- …to appropriate departments + Monitors Concurrent Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per department protocol (IPRO ... Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in Allscripts + Meets...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials +… more
- Magellan Health Services (Boise, ID)
- …Doctoral level provider. General Job Information Title Clinical Manager, Behavioral Health ( UM ) -Licensed, Remote in Idaho Grade 27 Work Experience - Required ... Mgmt, PC - Professional Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care MgmtCare Mgmt License and Certifications… more
- Magellan Health Services (Boise, ID)
- …that directly influence quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience - Required Clinical ... - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- Position Summary: The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates ... other duties as assigned. Job Qualifications: Valid license as a Licensed Vocational Nurse issued by the State of California. High school diploma or equivalent… more
- CVS Health (Oklahoma City, OK)
- …OK state independent Behavioral Health clinicianlicense or a Registered Nurse (RN) with psychiatric specialty,certification, or Behavioral Health experience + ... Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty, certification, or… more
- Queen's Health System (Honolulu, HI)
- …EDUCATION/CERTIFICATION AND LICENSURE: * Current Hawaii State license as a Registered Nurse . * Bachelor's degree in Nursing. * Master's degree in Nursing preferred. ... B. EXPERIENCE: * Five (5) years nursing experience with at least three (3) years experience in Case Management. * Two (2) years supervisory/leadership experience. * Prior experience in a comparable role highly preferred. * Experience to demonstrate: o… 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 within a ... multidisciplinary team to help identify and manage members who are in need of additional care 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 (San Diego, CA)
- …whenever possible in collaboration with off-tour charge RNs. 16. Directly reports to the Nurse Manager of CNSO & UM and/or designee. 17.Performs other duties as ... Summary The Nursing Officer of the Day is a registered professional nurse , responsible for maintaining safe patient care by providing leadership and support to the… more
- Omaha Children's Hospital (Omaha, NE)
- …including veterans and people with disabilities. **A Brief Overview** Utilization Management ( UM ) is a specialty area of Nursing Case Management (NCM) and is ... demonstrates the appropriate intensity of service for the severity of illness. UM includes retrospective and concurrent clinical reviews with third-party payors and… more
