- CVS Health (Annapolis, MD)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in ET zones. **Education**… more
- CVS Health (Raleigh, NC)
- …to work Monday through Friday, 9:00am to 5:30pm EST with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include ... holidays and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + Experience using… more
- CVS Health (Frankfort, KY)
- …- SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… more
- PruittHealth (Columbia, SC)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required… 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 (Annapolis, MD)
- …Skilled Nursing (SNF) and Assisted Living (ALF) facilities. The Clinical Nurse Specialist/Infusion Educator for LTC (Long Term Care) will work collaboratively ... of the work week are considered office days to plan visits. The Clinical Nurse Specialist/Infusion Educator LTC is responsible for the below, most of which must be… 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
- Access Dubuque (Dubuque, IA)
- …degree nursing program.** **Active and current license for Registered Nurse ** **Active and current International Board-Certified Lactation Consultant ... Lactation Consultant - Birth Center **MercyOne** 1 Positions ID:...health and wellness, particularly as it relates to breastfeeding management and early parenting issues.** **Helps breastfeeding women and… more
- McLaren Health Care (Lansing, MI)
- …the Patient Care Coordinator or Patient Care Manager, the Certified Lactation Consultant independently provides consultations to management for routine and ... or Practical Nurse by State of Michigan. * Certified Lactation Consultant (IBCLC) by the International Board of Lactation Consultant Examiners. * American… more
- MyFlorida (Orlando, FL)
- …Bachelor's Degree in any other discipline with at least 6 months of direct case management experience or a Florida Licensed Registered Nurse (RN) with 1-year of ... HUMAN SERVICES PROGRAM CONSULTANT II - 64006362 Date: Jun 4, 2025...(CBO's). Incumbent reports directly to the Supervisor of Case Management . Staff will establish and maintain a caseload of… more
- Highmark Health (Richmond, VA)
- … **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a ... in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant (PA) **Preferred** +… more
- Veterans Affairs, Veterans Health Administration (Coatesville, PA)
- …management , and customer satisfaction throughout the continuum of care. Responsibilities The Nurse Quality Management (QM) Consultant Registered Nurse ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: Experience in utilization management reviews and/ or accreditation. Physical… more
- The Arora Group (Bethesda, MD)
- …Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty ... case-managed patients, throughout the continuum of care. + Conduct training in nurse case management for professional and paraprofessionals personnel, within the… more
- Trinity Health (Mishawaka, IN)
- …for quality care. **JOB SUMMARY:** The inpatient **Certified Wound Ostomy Continency Consultant (CWOCN Consultant ), Registered Nurse ** will provide clinical ... and their family members to assist them in the management of their individual wound care needs. Ultimate responsibility...for the patient, unit based resource nurses and the Nurse Manager of each unit. The CWOCN Consultant… more
- Albany Medical Center (Albany, NY)
- …proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to ... assigned service. Acute care nursing experience preferred.4. Recent experience in case management , utilization management and/or discharge planning/home care… more
- Veterans Affairs, Veterans Health Administration (Shreveport, LA)
- …Nonskilled In-Home Care, Care Coordination / Integrated Case Management , Utilization Management , Care Coordinators, and Nurse Educators. Responsibilities ... for Specialty Programs functions as an advisor, administrator, educator, consultant , and mentor who possesses a wide range of...within Virtual Care, Case Management /Care Coordination, and Utilization Management . The Chief Nurse … more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title: Clinical Nurse -WoundCare-WOCN-Mount Sinai Hospital-FT/Days** The Nurse Clinician is a registered professional nurse who ... skills in an area of clinical nursing specialization. The nurse clinician is able to guide and promote the...Patient/Family education 3) D/C planning and follow-up 4) Case management 5) Research + Maintains clinical expertise in area… more
- Avera (Sioux Center, IA)
- …Christian culture. **Registered Nurse ** **Job Summary** + The RN assists the Resource Nurse in the management and care of their assigned patients by means of ... and patient teaching. Participate in educational programs as an educator/ consultant (if applicable). **General Hours of Work** + Full...Nurse ** **Summary** + The LPN assists the registered nurse in the management and care of… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …of the RAI/MDS Assessment for resident care planning. Collaborates with the CLC management or charge nurse to support the CLC Interdisciplinary Team members ... and CLC compare. Responsible for downloading, validating, and distributing quality management and Resource Utilization Group (RUG) reports and distributing them… more
- Veterans Affairs, Veterans Health Administration (Asheville, NC)
- Summary Care Management has an opening for one Registered Nurse located within Referral Coordination Service (RCS) . The incumbent practices as an RN on the ... medical centers. Outpatient specialty clinic care coordination and patient flow management , including appointment management . Collaborates with clinic staff to… more
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