- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Battelle Memorial Institute (Fort Benning, GA)
- …two years' nursing experience + Current, full, active, and unrestricted license as a Registered Nurse in any US State, the District of Columbia, Guam, Puerto ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report… more
- Commonwealth Care Alliance (Springfield, MA)
- …success. + Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges. + Represent ... + Lead the monitoring and analysis of provider performance using utilization , quality, and member experience metrics. + Collaborate with Business Intelligence,… more
- Commonwealth Care Alliance (Boston, MA)
- …understanding of CCA's mission, value-based approach, and expectations for quality, utilization , and member experience. - Address provider inquiries related to care ... coordination, utilization management, and program participation, collaborating with internal teams...BH and Health Home providers. - Participate in case review meetings and rounds as needed to enhance coordination… more
- Parexel (Trenton, NJ)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable...ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or… 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
- Actalent (Atlanta, GA)
- Job Title: Utilization Review - FULLY REMOTE ...Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse ( RN ) with a valid ... + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Work...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...+ 3+ years of clinical nursing experience as an RN , preferably in a hospital setting + Utilization… more
- Providence (Mission Hills, CA)
- **Description** ** RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day ... must empower them. **Required Qualifications:** + Associate's Degree - Nursing. + California Registered Nurse License upon hire. + 2 years - Experience working… more
- Providence (Mission Hills, CA)
- **Description** ** RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Full- time and will work 8-hour, Day ... empower them. **Required Qualifications:** + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Experience working in a … more
- Henry Ford Health System (Warren, MI)
- …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse with a valid, unrestricted State of Michigan License.… more
- Cognizant (Annapolis, MD)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Banner Health (Phoenix, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... better nursing. Our Care Management staff is seeking an RN Case Manager to work closely with members seeking...telephonic, home visits, and televisit platforms. It is fully remote with the exception of a few in person… more
- Bon Secours Mercy Health (SC)
- …clinical and operational excellence. **Summary of Primary Function** In the capacity of a Registered Nurse ( RN ), the Ambulatory Care Manager will provide ... Nursing Bachelor's Degree (preferred) Specialty/Major- Nursing (BSN) **Licensing/ Certification** Registered Nurse with active License in State of… more
- CVS Health (Hartford, CT)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- HCA Healthcare (Mcallen, TX)
- …to physicians, patients, families and caregivers **What qualifications you will need:** + ( RN ) Registered Nurse + Bachelors Degree Preferred, or Associate ... your knowledge and expertise! **Job Summary and Qualifications** The RN case manager is responsible to facilitate care along...encourage you to apply for our Registered Nurse Case Manager PRN opening. We review … more
- US Tech Solutions (Columbia, SC)
- …3 years clinical experience or 2 years clinical experience plus 1 year utilization /medical review , quality assurance, or home health. **Skills:** + Working ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...and if progressing well, can be moved to work remote . + Prefer 2 yrs. UM and/or appeals experience.… more
- Blue KC (MO)
- …and regularly attends client meetings (with benefits managers and executives) to review health outcomes and cost information. + Actively monitors care management ... special consideration (eg, benefits) should be made. + Participate in existing client utilization and renewal meetings or tell our clinical value story as requested.… more
- Humana (Lincoln, NE)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
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