- 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 ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to establish the most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process changes + Maintains… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker AFB, ... and databases for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case management with social work case management. -… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …and ensures these requirements are accurately followed and Utilization Management ( UM ) decision determinations and timeliness standards are within compliance. + ... (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + Utilization… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …and ensures these requirements are accurately followed and Utilization Management ( UM ) decision determinations and timeliness standards are within compliance + ... (4) years' work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by State law **(Required)** + Three (3) years… more
- Stony Brook University (Stony Brook, NY)
- …and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history of 5 ... be able to prioritize their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge of MCG or Interqual… more
- 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. This ... clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and… more
- CenterWell (Atlanta, GA)
- …caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking ... make an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non compact… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are ... overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday… more
- Humana (Charleston, WV)
- …and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and ... and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and frequently require interpretation… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …for the UM microsystem that impacts operations or resources. The proficient UM nurse demonstrates critical thinking with efficiency and accuracy in assessing ... point of care. Practice is enhanced through development of collegial relationships. The UM /Float Nurse demonstrates collaboration by using the group process to… more
- CVS Health (Harrisburg, PA)
- …and evening hours._ _This positions hours will be M-F with Weekend/Holiday Rotation._ ** 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 (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity of care and… more
- Saint Francis Health System (OK)
- …various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of related experience in… more
- Trinity Health (Langhorne, PA)
- …experienced Registered Nurse to join our team in Utilization Review! The UM Registered Nurse is responsible for the coordinating and facilitating all aspects ... of reimbursement as related to the clinical review and level of care. Management of all review and appeals utilizing a modified approach based on specific needs of the patient population. Facilitates achievement of efficient resource consumption, and… more
- YesCare Corp (Brentwood, TN)
- …contract specific time frame to ensure resources are maximized. + Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment in the ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...factors. + Will work in collaboration with other contract UM Specialists, YesCare's consulting physicians, RMDs, UMMDs, and Site… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is hiring a full-time Behavioral Health UM Care Manager to support our UM Clinical Operations team. This role will primarily work Monday - ... review requests for authorization for behavioral health services. The Utilization Management ( UM ) Care Manager is responsible for utilization review of health plan… more
- Penn State Health (Hershey, PA)
- …**SUMMARY OF POSITION:** Under the direction of a Utilization Management Nurse or Specialist, the Utilization Management Coordinator supports the UM ... **PREFERRED QUALIFICATION(S):** + Certified Medical Assistant (MA) or Licensed Practical Nurse (LPN) **WHY PENN STATE HEALTH?** Penn State Health offers exceptional… more
- Molina Healthcare (Syracuse, NY)
- …surgical, emergency room, intensive care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours: Monday - Friday 8:00am- ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** * At least 2 years experience,… 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
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