- Moses/Weitzman Health System (Meriden, CT)
- …licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or ... health care activities as agreed, eg school based clinic consultant , SNF care. Administrative Maintains board certification/licensure. Attends continuing education… more
- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote. ... As a Utilization Nurse Consultant , you will utilize clinical skills...to coordinate, document and communicate all aspects of the utilization /benefit management program and our plan sponsor(s).… more
- CVS Health (Atlanta, GA)
- …do it all with heart, each and every day. **Position Summary** Medicare Predetermination Utilization Management Nurse Consultant position: _Utilization ... with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience +… more
- CVS Health (Phoenix, AZ)
- …the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- CVS Health (Austin, TX)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CT zones **Education**… more
- CVS Health (Columbus, OH)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** 3+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...experience as an Registered Nurse Active and unrestricted RN licensure in state of… more
- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring… more
- CVS Health (Springfield, IL)
- …+ **M** anaged care experience + Discharge planning experience + Utilization Management experience **Education** ASN Required, BSN Preferred **Anticipated ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- CVS Health (Baton Rouge, LA)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications : + Independent… more
- CVS Health (Topeka, KS)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Quality Management (QM) Consultant Registered Nurse (RN) demonstrates leadership, experience, & creative approaches to improvement in ... quality-of-care outcomes. The QM Consultant demonstrates performance & leadership that is broad enough to improve the care for a group of patients. They are… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …the least restrictive, most cost-effective manner, through use of outpatient utilization management criteria, clinical practice guidelines and clinical pathways. ... and initiatives as well as customer service programs. Clinical Registered Nurse (RN) Consultant executes position responsibilities that demonstrates leadership,… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for VISN 10 and/or VISN 12 ... of appropriate evidence-based practices for positive outcomes. Responsibilities The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is directly… more
- CVS Health (Annapolis, MD)
- …we do it all with heart, each and every day. Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of ... efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of… more
- US Tech Solutions (RI)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. **Skills:** + MUST HAVE… more
- CVS Health (Austin, TX)
- …in managed care, clinical, or health care related field. - 1 year of project management experience. - Registered Nurse (RN) license in the state of their ... in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. - Provides training and… more
- CVS Health (Columbus, OH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their...care/medical experience. + 1+ years of Appeals experience in Utilization Management + 3+ years utilization… more
- CVS Health (Portland, OR)
- …with heart, each and every day. **Job Purpose and Summary:** The Field Nurse LPN will conduct quality reviews and provide education specific to medication compliance ... care: + Meet with customers to present Omnicare Nursing Services and promote utilization of support tools and programs + Evaluate regulatory compliance and determine… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for...external committees as delegated or assigned. Serves as a consultant to other departments or organizations as needed. Responsible… more
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