- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... on department activities. Essential Skills + Clinical review + Utilization review + Utilization management ...medical record software Work Environment The role offers a hybrid work schedule post-training, with hours from Monday to… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Humana (Charleston, WV)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action at an onsite facility. This hybrid position will have limited hours working at home… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... of medical services, discharges and/or benefit administration determinations. The Utilization Management Nurse 2 work...an on-site facility. This position will have a limited hybrid with some hours working at home at leader… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- Elevance Health (Morgantown, WV)
- RN Utilization Management /Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review)...to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. The Clinical Care Reviewer - Utilization Management will also be counted upon...Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse (RN) license in the District of Columbia in… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** +… more
- Elevance Health (Woodbridge, VA)
- …and adaptable workplace. The office is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the most complex or challenging ... RN Utilization Review Nurse (Washington DC Medicaid)...the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred.… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Centene Corporation (Austin, TX)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Jefferson City, MO)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Humana (Pierre, SD)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- CVS Health (Charleston, WV)
- …all with heart, each and every day. **Position Summary** **Brief Overview** This is a Hybrid role. The Care Manager RN will be responsible to work from home as well ... The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning,… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability ... abstraction & entry of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer equipment, encrypted zip drives… more
- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... immediate support. **Build the Possibilities. Make an extraordinary impact.** The ** Utilization Management Representative II - Prior Authorization** is… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- Elevance Health (Tampa, FL)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- Centene Corporation (New York, NY)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Jefferson City, MO)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more