- CVS Health (Trenton, NJ)
- …on rotation. No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in a ... our benefit programs, please visithttps://jobs.cvshealth.com/employee-benefits (https://protect-usb.mimecast.com/s/HChtCEKL7mupo2P4Q84HN2Ovk?domain=jobs.cvshealth.com) Required Qualifications Registered Nurse in state of residence 3+ years of Nursing… more
- CVS Health (Hartford, CT)
- …verbal and written Required Qualifications + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure in state of ... our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k)… more
- CVS Health (Lansing, MI)
- …nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Sedentary work involves periods of sitting, ... our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k)… more
- CVS Health (Montgomery, AL)
- …our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) ... unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents… more
- Kepro (Richmond, VA)
- …partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer RN to join our growing team. Job Summary: Our Clinical ... Reviewer RN will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and… more
- CVS Health (Raleigh, NC)
- …(typically 1 holiday per year). There is no travel expected with this position. This UM Nurse Consultant position is part of Aetna's Commercial Care ... and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing):… more
- CVS Health (Columbus, OH)
- …9:30am-6:00 pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a ... care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- CVS Health (Trenton, NJ)
- … role is fully remote and employee can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process ... populations - MCG experience - Managed care experience - UM Certification - MedCompass - 1+ year(s) of inpatient...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- CVS Health (Columbus, OH)
- …health care more personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee ... Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- CVS Health (Columbus, OH)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is...- Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit… more
- CVS Health (Columbus, OH)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is...-Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit… more
- CVS Health (Austin, TX)
- …federal and state regulated turn-around times. This includes reviewing written clinical records.The UM Nurse Consultant job duties include (not all ... personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is...encompassing):- Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit… more
- CVS Health (Plantation, FL)
- …Monday-Friday; 10:00 AM- 6:30 PM EST No nights, no weekends, and no holidays. The UM Nurse Consultant job duties include (not all encompassing): -Reviews ... services to assure medical necessity, applies clinical expertise to assure appropriate benefit...Compact RN License or license in multiple states + UM Nurse Consultant experience +… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary Duals UM Nurse Consultant Pennsylvania - Institutional Special Needs Plan ... - Utilization Review experience preferred - Managed care experience - UM /CM/MCG Certification - Med Compass Experience Education Associates Degree required BSN… more
- CVS Health (Phoenix, AZ)
- …to work on Arizona time zone. No weekends, holidays are required. The UM Clinical Consultant utilizes clinical skills to coordinate, document and communicate ... thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. Consults and… more
- CVS Health (Phoenix, AZ)
- …Eastern Time Shift. + Work with providers to secure information to complete medical necessity reviews for Oncology and Transplant related services. + MUST have the ... nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Position requires proficiency with computer… more
- CVS Health (Columbus, OH)
- …Medicare/Medicaid - Managed care (MCO) experience - Med Compass experience - CM/ UM Certification Education Associates Degree required BSN preferred Pay Range The ... our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k)… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria ... of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual contributor while collaborating… more
- Veterans Affairs, Veterans Health Administration (Vancouver, WA)
- …to UM and BMS. In fulfilling these responsibilities, the UM Nurse Specialist serves as an administrator, educator, consultant , and mentor to Network and ... high degree of leadership, motivation, self-direction, and initiative in UM /BMS/activities. The UM Nurse Specialist...both administrative and clinical services at the Network and Medical Center levels to facilitate and monitor the quality,… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN) Case Manager to work the Directorate of Healthcare Operations (DHO) at ... Walter Reed National Military Medical Center, Bethesda, Maryland. Full-time, Monday - Friday between...provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER (RN): The contracted RN shall provide… more