- Commonwealth Care Alliance (Boston, MA)
- …**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 Nurse Utilization Management Reviewer has a key role in… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management ** for a temporary contract position in support of ... AFB, CA (https://www.airforcemedicine.af.mil/MTF/Vandenberg/About-Us/) . **NOTE: This is NOT a Tele-Health/ Remote Practice Opportunity.** **Be the Best!** Join our team… more
- BlueCross BlueShield of Tennessee (Memphis, TN)
- …we'd love to have you on our team\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases as needed\. ... looking for individuals with strong critical thinking skills, excellent time management , and the ability to prioritize task efficiently\. If you're self\-motivated… more
- Commonwealth Care Alliance (Springfield, MA)
- …(CCA) Care Delivery programing is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel ... significant medical, behavioral, and social complexities that require intensive care management and care delivery. Care Delivery comprises of multiple program lines… more
- Teleflex (Tampa, FL)
- …market today, from our world-class brands including: + LMA and Rusch airway management devices designed to help reduce the risk of airway-related complications. + ... Arrow pain management products designed to improve patients' post-operative pain experience. Join a dynamic, growing team that offers healthcare providers advanced… more
- Commonwealth Care Alliance (Boston, MA)
- …the Primary Care Nursing Manager will collaborate closely with other members of the management team. This role is full-time on site in our Boston clinic and will ... Springfield and Worcester locations, as needed, as well as supervision of fully remote employees. Massachusetts Market Contract Key Personnel: - No, this position is… more
- CVS Health (Phoenix, AZ)
- …members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- Actalent (San Antonio, TX)
- …ensure the necessity and appropriate setting of care. Qualifications: + 2+ Years of Utilization Management Experience is Mandatory + Active Compact RN License is ... Urgent Hiring for " Remote Clinical Review RN" Job Description: + Perform...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- CVS Health (Phoenix, AZ)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and ... shifts: 9:00am-5:30pm, 9:30am-6:00pm, 10:00am-6:30pm, or 11:30am-8:00pm EST Hours) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH),… more
- CVS Health (Richmond, VA)
- …with heart, each and every day. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote . As a Utilization ... utilize clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program and our plan sponsor(s). You would be… more
- Martin's Point Health Care (Portland, ME)
- …of clinical nursing experience as an RN, preferably in a hospital setting + Utilization management experience in a health plan UM department Required License(s) ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible...to lower/higher levels of care, makes referrals for care management programs, and performs medical necessity reviews for retrospective… more
- Humana (Little Rock, AR)
- …and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham &...** **Location** : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse ... Utilization Management Nurse...also work closely with participants for referrals to case management and condition management services according to… more
- Humana (Boise, ID)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Columbus, OH)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** 3+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...schedule may include weekends, holidays, and evening hours._ Fully Remote - WFH **Position Summary** : Utilizes clinical experience and… more
- Actalent (Santa Barbara, CA)
- … Coordinator - REMOTE POSITION Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a contract ... 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote...a leading healthcare organization Job Description The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse … more
- CVS Health (Albany, NY)
- …do it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...experience. * At least 1 year of health care management /leadership experience. * Registered Nurse (RN), Licensed… more
- Molina Healthcare (GA)
- …of healthcare services professionals in some or all of the following functions: utilization management , care management , behavioral health and other ... of the following key health care services functions: care management , utilization management , care transitions,...and experience. * At least 3 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available; 1 week remote , 1 week onsite rotating; Monday-Friday, ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
