- 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 ... facilities to ensure consistent clinical evaluation and processing of medical necessity appeals. Accurate documentation and detailed recordkeeping of notifications… more
- 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 ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy +… more
- ERP International (Hurlburt Field, FL)
- …CM software, and databases for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case management with social ... **Overview** ERP International is seeking a full time **Registered Nurse (RN) Case Manager** in support of the 1st...Case Manager** in support of the 1st Special Operations Medical Group at Hurlburt Field, FL. **Be the Best!**… more
- ERP International (Twentynine Palms, CA)
- …CM software, and databases for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case management with social ... **Overview** ERP International is seeking **Registered Nurse (RN) Case Managers** for full-time positions in...Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays!** Medical /Dental/Vision, STD, LTD and Life Insurance, Health Savings Account… more
- ERP International (Tinker AFB, OK)
- …case management functions: a)Assessment:Identification of patients for case management ; comprehensive collection of patient information and medical status; ... **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position...databases for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case … more
- Stony Brook University (Stony Brook, NY)
- …high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following but are not limited to:** + Completes ... projects as assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were readmitted within… more
- Veterans Affairs, Veterans Health Administration (Johnson City, TN)
- Summary The UM Nurse shares the responsibility for planning, implementation, and evaluation of both the clinical and administrative services aspects of its ... don protective clothing in isolation situations or operative/invasive procedures. The QM Clinical Nurse Analyst/ UM Nurse may occasionally be exposed to… 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. ... for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical… more
- Molina Healthcare (Long Beach, CA)
- …Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, ... Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional...looking for LVN's with at least 4 years of UM experience, NCQA accreditation, and knowledge of InterQual /… more
- Molina Healthcare (CA)
- JOB DESCRIPTION **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing ... for LVN's with at least 2 years of experience with the following: UM , Prior Authorization, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent… more
- Molina Healthcare (Salt Lake City, UT)
- …may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/appeals. * Provides ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours:… more
- CVS Health (Harrisburg, PA)
- …we do it all with heart, each and every day. **Position Summary** _Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and ... constituents in the coordination and administration of the utilization/benefit management function. + Typical office working environment with productivity and… 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 ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** * At least… 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
- Integra Partners (Troy, MI)
- … UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: ... will play a key role in collaborating with our Medical Director to perform benefit and medical ...+ Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan… more
- Corewell Health (Grand Rapids, MI)
- …nursing and or case management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life Support (BLS) ... Friday (4 hours), mostly remote, occasional on-site About the Department: RN UM - Supporting the insurance coordination functions for the Helen DeVos Children's… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Utilization Management ( UM ) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative ... management of complex utilization processes. Practical experience in the application of UM methods and expertise in medical necessity review criteria. This… more
- Veterans Affairs, Veterans Health Administration (Prescott, AZ)
- Summary Northern Arizona VA Health Care System is looking for a Registered Nurse - Utilization Management to join the Quality & Patient Safety team! ... Duties include, but are not limited to: The Utilization Management Coordinator (UMC) is a registered professional nurse...for providing the clinical expertise and leadership of the medical center's UM Program. The UMC possesses… 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 (Phoenix, AZ)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In ... (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
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