- 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
- CVS Health (Lansing, MI)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant - Oncology and Transplant to join our remote ... of a computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity… 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
- US Tech Solutions (May, OK)
- **Duration: 06 months contract** **Position Summary** + The UM Nurse Associate I is responsible for reviewing and completing criteria-based prior authorizations ... in compliance with company policies and procedures. This role provides after-hours nurse availability for urgent prior authorization requests, supports the PA team… 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
- 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
- Humana (Lansing, MI)
- …community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical thinking ... appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers, Enrollees, or other… more
- University of Michigan (Ann Arbor, MI)
- NURSE RECRUITER ( Nurse & PA Recruitment...Leadership candidates with the greatest potential for success at UM Health. + Partner with nursing, APP and hiring ... **Responsibilities The University of Michigan Health (UMH), Michigan Medicine Nurse and PA Recruiter will be responsible for developing...employer brand presence. + Act as a liaison with UM School of Nursing and develop partnerships with local… 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
- LA Care Health Plan (Los Angeles, CA)
- …for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission… more
- Veterans Affairs, Veterans Health Administration (Leeds, MA)
- Summary This Registered Nurse position is in Nursing Service at the VA Central Western Massachusetts Healthcare System, located in Leeds, Ma. This is a full time 40 ... teams to ensure proper utilization of healthcare resources. Develop and implement UM policies and procedures in compliance with VHA standards. Utilize data to… more
Related Job Searches:
Clinical/um Nurse 2,
Nurse,
UM Nurse Compact RN,
UM Nurse Consultant,
UM Nurse Consultant RN,
UM Nurse Consultant Remote,
UM Nurse Medical Management