- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Centene Corporation (New York, NY)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- AmeriHealth Caritas (Lafayette, LA)
- …fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse ( RN ) license in Louisiana or multi state license ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical...organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems (eg, JIVA) to efficiently… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm...Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer...+ Licensure in additional states a plus. + For registered nurses only: a bachelor's degree in (BSN) preferred.… more
- Humana (Lincoln, NE)
- **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...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- AnMed Health (Anderson, SC)
- …, continued stay/concurrent review , retrospective review , bed status management , resource utilization management , regulatory compliance, and related ... issues. Duties & Responsibilities + Performs assigned utilization management functions daily: initial, concurrent and retrospective review of the… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- University of Michigan (Ann Arbor, MI)
- …as assigned DAILY WORK DUTIES 1. Insurance Alert Changes from software system for utilization management : notify RN CM if additional clinicals are required ... Utilization Management Assistant (Patient Services Intermediate)...retirement savings **Responsibilities Essential: 1. Data entry of clinical review information for online authorizations into multiple web sites… more
- Intermountain Health (Las Vegas, NV)
- …The Manager of Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, ... Improvement + Scheduling **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in...+ Previous management experience in hospital care management , utilization review , ambulatory care… more
- Brighton Health Plan Solutions, LLC (NC)
- …Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with ... regulatory and accreditation requirements. * Duties as assigned. Essential Qualifications * Current Registered Nurse ( RN ) with state licensure. Must retain… more
- Saint Francis Health System (OK)
- …in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale… more
- AdventHealth (Tampa, FL)
- …other diseases. **The role you'll contribute:** The Utilization Management nurse uses clinical expertise to review patient records in the emergency ... emergency department setting. Utilize critical thinking and expertise in utilization review regarding medical necessity, patient status,...nursing in an acute care setting - preferred + Utilization Management or Care Management … more
- CVS Health (Columbus, OH)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** - Utilization review experience preferred - Knowledge of Medicare/Medicaid ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** - 2+ years of… more
- Penn State Health (Hershey, PA)
- …prohibit or outlaw discrimination._ **Union:** SEIU Healthcare Pennsylvania **Position** RN Registered Nurse Utilization Management Specialist - ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing… more
- Sanford Health (Sioux Falls, SD)
- …for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to… more