- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- UPMC (Pittsburgh, PA)
- …and Clearances: + Case management certification or approved clinical certification preferred + Registered Nurse ( RN ) *Current licensure either in the state ... Preference will be given to candidates with a Pennsylvania RN license. This role will review requests...behavioral health services. The Utilization Management ( UM ) Care Manager is responsible for utilization review … more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays...vital role in ensuring the delivery of high-quality, evidence-based care . This position is responsible for reviewing and evaluating… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. + Document review … 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 ... timely clinical and service authorization review for medical necessity and decision-making. The ...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance… more
- Molina Healthcare (Salt Lake City, UT)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience… more
- Trinity Health (Langhorne, PA)
- … Registered Nurse to join our team in Utilization Review ! The UM Registered Nurse is responsible for the coordinating and facilitating all aspects ... of reimbursement as related to the clinical review and level of care . Management of...+ Bachelor's degree in nursing required. + Active PA RN License required. + CCM or Accredited Case Manager… more
- Actalent (Atlanta, GA)
- Utilization Review - Registered Nurse Job...UM ). + 1+ years of experience in managed care . Additional Skills & Qualifications + Experience with MCG or ... + Conduct quality improvement reviews. + Communicate with inpatient care coordinators, case managers, SNF/Rehab care coordinators,...Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse ( RN ) with a… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... First Refusal (ROFR) requests, review of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Cardiovascular Center- CVC 5,...to deliver the safest and highest quality of health care . Applicants are expected to review the ... opportunity employer. **Job Detail** **Job Opening ID** 269110 **Working Title** REGISTERED NURSE (Cardiovascular Center- CVC 5, Adult Intermediate… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE ( Cardiovascular Center- CPU...to deliver the safest and highest quality of health care . Applicants are expected to review the ... equal employment opportunity employer. **Job Detail** **Job Opening ID** 270971 **Working Title** REGISTERED NURSE ( Cardiovascular Center- CPU - EP Lab) **Job… more
- US Tech Solutions (Wichita, KS)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior ... CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . +... Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
- University of Miami (Miami, FL)
- …. CORE JOB SUMMARY The Registered Nurse 2 delivers patient-family centered care in ... of quality, safety, and service while ensuring population-specific patient care . The Registered Nurse 2...necessary. Serves as mentor and role model Compliance with UM , Hospital and department policies and procedures Other duties… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Registered Nurse works as a part of a ... team to provide quality care to designated patients. The RN works...are not limited to: Performance Nursing Duties as per Nurse Job Description 100% Perform patient interview and obtains… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers… more
- University of Miami (Miami, FL)
- …not require direct physician involvement as per physician orders and within the scope of RN licensure 7. Renders dire ct patient care by assisting providers with ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Sign on Bonus:… more
- US Tech Solutions (Columbia, SC)
- **Duration: 3+ Months Contract (Possible temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted SC RN license. + ... be moved to work remote. + Prefer 2 yrs. UM and/or appeals experience. + Experience with prior insurance,...+ Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review … more
- Humana (Charleston, WV)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Guthrie (Sayre, PA)
- Up To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse ( RN ) Utilization Management ( UM ) in collaboration with Care Coordination, ... of patient status. + Collaborate and set standards with registered nurse ( RN ) case managers... within a professional manner. + Document and escalate UM quality and clinical care risks concerns… more
- Molina Healthcare (Dallas, TX)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Fully remote opportunity for a TX licensed RN with Utilization Management experience to join our Prior...* Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM… more