- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is knowledgeable… more
- CVS Health (Columbus, OH)
- …**Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a field-based/Remote position out of the ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- CVS Health (Little Rock, AR)
- …holidays, and evening hours As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... aspects of the utilization /benefit management program. + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Harrisburg, PA)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- CVS Health (Harrisburg, PA)
- …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 EST zones.… 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 (Springfield, IL)
- …3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
- CVS Health (Jefferson City, MO)
- …+ 1+ years of MS Office suite experience **Preferred Qualifications** + Precertification/ Utilization Management experience + Preference for nurses in Pacific ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of… more
- CVS Health (Albany, NY)
- …with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications** ... do it all with heart, each and every day. **Position Summary** This ** Utilization Manager** position is with Aetna's Long-Term Services and Supports (LTSS) team and… more
- Guidehouse (Chicago, IL)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and operational improvement across business and purchased services, supply cost, and clinical supply utilization at client provider organizations. Our team of… more
- Guardian Life (Bethlehem, PA)
- The **Senior RN Clinical Consultant ** will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical ... managing and resolving issues that come up related to clinical processes, claim management activities, customer inquiries,...+ Provide ongoing training, coaching and development to all Clinical Consultant members + Organize and present… more
- Houston Methodist (Houston, TX)
- …Center for Performing Arts Medicine. At Houston Methodist, the Speech Pathologist (SP) Clinical Consultant position is responsible for functioning as a licensed ... and acuities on an outpatient basis. As an experienced Therapist, the SP Clinical Consultant position provides education to patients, patient's family members… more
- Child Communication and Behavior Specialists (CA)
- …and culturally inclusive environment. The Position We are seeking a Remote BCBA Supervisor & Clinical Consultant to join our team. This role is 100% remote with ... individualized, high-quality ABA programs. Key Responsibilities + Provide hands-on clinical supervision using Behavioral Skills Training (BST). + Facilitate… more
- Ochsner Health (New Orleans, LA)
- …at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management ) serves as the physician leader in matters relating ... the Interdisciplinary and Post-Acute teams, Payors, Administration and Revenue Cycle) to improve utilization management , sustain quality goals, and act as a … more
- Highmark Health (Richmond, VA)
- …+ Deep Clincal Expertise -extensive knowledge of clinical , quality, care, utilization , high-cost claim, and population health management . Must be a ... Description :** **JOB SUMMARY** This job serves as the sales team's clinical expert, providing high-level support and insights for strategic clients, aligning… 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: ... 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
- Sutter Health (Sacramento, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... quality regulations. The PA will act as a liaison between the CDI ( Clinical Documentation Improvement) professional, HIM (Health Information Management ) ,and… more
- Boehringer Ingelheim (Ridgefield, CT)
- **Description** The Cardiovascular-Renal Sales Consultant is responsible for partnering in developing and implementing a plan for brand sales growth of BIPI and ... and with BIPI guidelines, policies, and directives. The Cardiovascular-Renal Sales Consultant will conduct their business with key targeted healthcare providers… 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 ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
- Trinity Health (Pontiac, MI)
- …including senior management . + Proficiency with or ability to learn clinical information systems supporting PRM (Physician Relationship Management tools) + ... access, service and other operational issues identified by surgeons that inhibit utilization of and referrals to Trinity Health facilities, physicians, and services.… more