- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Utilization Management ** for a temporary contract position in support ... AFB, CA (https://www.airforcemedicine.af.mil/MTF/Vandenberg/About-Us/) . **NOTE: This is NOT a Tele-Health/ Remote Practice Opportunity.** **Be the Best!** Join our team… more
- Somatus (Utica, NY)
- …utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management ... telephonically as the need arises. **This is a fully remote role where New York licensure is required.** **The...Uses protocols and pathways in line with established disease management and care management programs and approved… more
- Conifer Revenue Cycle Solutions (Frisco, TX)
- …(2) years supervisory experience CERTIFICATES, LICENSES, REGISTRATIONS Preferred: Active state Registered Nurse license or Certified Coding Specialist credential ... development and implementation, and ongoing success of the Clinical Documentation Management Program. Educates members of the patient care team regarding… more
- Commonwealth Care Alliance (Springfield, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... programing is responsible for providing care delivery and care management to a specific panel of high risk and...Supervision Exercised: Yes - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- BlueCross BlueShield of Tennessee (Memphis, TN)
- …this position\. + This job requires digital literacy assessment\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... have you on our team\. **Job Responsibilities** + Supporting utilization management functions for more complex and...their residence if the state is participating in the Nurse Licensure Compact Law\. _Experience_ + 3 years \-… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... Manager will collaborate closely with other members of the management team. This role is full-time on site in...role. Supervision Exercised: - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- Parexel (Oklahoma City, OK)
- …Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- Teleflex (Tampa, FL)
- …based Sales Representative, Anesthesia, is making connections with anesthesiologists, Certified Registered Nurse Anesthetist's (CRNA's), other members of the ... our world-class brands including: + LMA and Rusch airway management devices designed to help reduce the risk of...business plan. - Grow overall market share and increase utilization among existing accounts, while securing new users within… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... overall member experience. **Working Conditions:** + This is a remote or hyrbrid role with the expectation of working...& Language (nice to have):** + Familiarity with care management and utilization management systems… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... and phone calls Working Conditions: - This is a remote or hybrid role with the expectation of working...& Language (nice to have): - Familiarity with care management and utilization management systems… more
- SR International, Inc. (Phoenix, AZ)
- …their own laptop SOAZ - Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote /Onsite Trainings) Skills Required: *Medical nursing practice, medical ... times for training once starting position Compliance Items: Active RN License in state of Arizona Fingerprint Clearance Card...case management protocols, quality management and … more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- Commonwealth Care Alliance (Boston, MA)
- 011330 CCA-Clin Operations & Implementation **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... and presents results. + Develops and analyzes quantitative reports to assess utilization , productivity and adherence to policies and procedures related to various… more
- CVS Health (Albany, NY)
- …do it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state ... Friday, 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- Cognizant (Carson City, NV)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Molina Healthcare (GA)
- …experience. * At least 1 year of health care management /leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
- CVS Health (Little Rock, AR)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... needed. + 3+ years inpatient clinical experience as a Registered Nurse . + 3+ years of Managed...years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership… more
- Molina Healthcare (GA)
- …and experience. * At least 3 years health care management /leadership required. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
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