- 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 ... information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. - Bachelor's degree in… more
- Magellan Health Services (Boise, ID)
- …Thorough knowledge of healthcare services in physical health, behavioral health or other medical specialty area based on pod management . Considerable skill in ... Responsible for the management , direct supervision and coordination of clinical and/or...ASN considered with additional experience. Thorough knowledge of physical, medical specialty and/or mental health community resources and providers.… more
- Magellan Health Services (Boise, ID)
- …services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. + Provides telephone triage, crisis intervention and ... alternative plans of treatment when requests for services do not meet medical necessity criteria. + Participates in network development including identification and… more
- Queen's Health System (Honolulu, HI)
- …and clinical operations of Emergency Department and Inpatient Case Management services. * Develops, implements, monitors and evaluates for effectiveness, ... alignment with the strategic plan and vision of the Medical Center. * Ensures functions, activities, services, and programs...LICENSURE: * Current Hawaii State license as a Registered Nurse . * Bachelor's degree in Nursing. * Master's degree… more
- CVS Health (Oklahoma City, OK)
- …to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically ... based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. Utilizes clinical experience and skills… 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 ... 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
- Omaha Children's Hospital (Omaha, NE)
- …and observation status. UM is responsible for all facets of denial management due to medical necessity and works collaboratively with patient accounts, the ... veterans and people with disabilities. **A Brief Overview** Utilization Management ( UM ) is a specialty area of...Compact State Licensure Required and + RN-BC - Case Management Nurse Preferred Children's is the very… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent ... appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with...members. + Serves as a liaison between Humana utilization management ( UM ) operations and the State of… more
- CVS Health (Lansing, MI)
- …that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant - Oncology and Transplant to ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM… more
- University of Washington (Seattle, WA)
- …Utilization Management Nurse .** **POSITION HIGHLIGHTS** The goal of the **Utilization Management ( UM ) Nurse ** is to ensure delivery of optimal care ... and establishes and maintains an efficient, cost effective care management process by determining the medical necessity...and financial liability for patients all hospitalized patients. The UM Nurse communicates this information with the… more
- Omaha Children's Hospital (Omaha, NE)
- …and observation status. UM is responsible for all facets of denial management due to medical necessity and works collaboratively with patient accounts, the ... opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management ( UM ) is a specialty area of Nursing Case … more
- Blue KC (Workman, MN)
- …with medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization, issues authorization letters, and follows in ... targets for program performance as mutually agreed to by management team to maximize program value. Ensures compliance with...FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical … more
- University of Miami (Miami, FL)
- … Medical Training Lab at the Gordon Center is currently seeking a full time Nurse Educator - Medical Simulation and Education Lab to work in Miami, FL. The ... Nurse Educator provides clinical education to nursing and patient..., and critical thinking skills development. + Collaborates with medical providers, patient care staff, and unit management… 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
- 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 ... Duties Include but are not limited to: Conduct comprehensive reviews of medical records to assess the appropriateness, necessity, and efficiency of healthcare… more
- University of Michigan (Ann Arbor, MI)
- NURSE RECRUITER ( Nurse & PA Recruitment...world and has been the site of many groundbreaking medical and technological advancements since the opening of the ... U-M Medical School in 1850. Michigan Medicine is comprised of...**Responsibilities The University of Michigan Health (UMH), Michigan Medicine Nurse and PA Recruiter will be responsible for developing… more
- Actalent (Santa Barbara, CA)
- …HIPAA, Privacy, and Confidentiality laws and regulations. + Adhere to Health Plan, Medical Management , and Health Services policies and procedures. + Stay ... POSITION Non-profit healthcare network is looking for a utilization management registered nurse to join their team...providers. + Function as a collaborative member of the Medical Management /Health Services' multi-disciplinary medical … more
- University of Miami (Miami, FL)
- …. JOB DESCRIPTION UM Title: Senior Registered Nurse Supervisor's Title: OR Director Pain Management FLSA ... Non-Exempt Revision/Creation Date: April 24, 2014. Job Summary (Purpose and Function): The Pain Management Nurse will be a professional registered nurse who… more
- Humana (Boise, ID)
- …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills...of the appropriate courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM… more
- ERP International (Barksdale AFB, LA)
- …not limited to the following; + Assist with orientation and training of other Medical Management staff and assist inproviding, assessing, and improving a wide ... **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a...Adhere to the MHS and Military Department's or Joint Medical Commands' referral management policies to manage… more
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