- Aequor (New York, NY)
- …as an occupational nursing professional Minimum experience of 1-3 years in case management , utilization review and/or quality assurance Experience in ... services to employees within regulated scope of practice and disability case management . Experience/Education: MS/NP in nursing degree and current NP license in New… more
- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... manner and promotes the efficient and effective use of patient services. The Utilization Review Team's role in data collection, analysis and summarization… more
- UNC Health (Chapel Hill, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... appropriate case management referrals. Initiates appropriate social work referrals.3. Utilization Management Process - Performs utilization management… more
- UNC Health (Chapel Hill, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization … more
- CVS Health (Raleigh, NC)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant...Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience… more
- CVS Health (Raleigh, NC)
- …live in any state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... and deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- Humana (Richmond, VA)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge, communication skills, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Montgomery, AL)
- **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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- Humana (Columbus, OH)
- **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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... of services and care. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse Job...of case management and UR concepts + Utilization review of prior authorizations for medical ... physicians and other team members on issues related to utilization review (UR) including appropriate admissions and...and appropriate length of stay. Hard Skills + Active nurse licensure in the state of FL + Knowledge… more
- Insight Global (Philadelphia, PA)
- …A Healthcare Insurance company local to Philadelphia PA is looking to hire a Utilization Management Nurse (RN) to their delegation oversight & assessment ... license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or medicare/medicaid Experience/knowledge… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to support ... in Florida) Available to work 2 Holiday a year. The Utilization Management Nurse 2 Front End Review uses clinical knowledge, communication skills, and… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... Job Summary: Our Utilization Management Appeals Nurse -...requirements, including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies to physician reviewers for… more
- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance ... and send to me with QB - 4-5 years of Remote Utilization Management experience at Payors, inpatient or outpatient - Proficiency… more
- Glens Falls Hospital (Glens Falls, NY)
- …foundhere. **Job:** **Nursing - Case Management * **Title:** *Registered Nurse - Utilization Review Nurse - Care Management * **Location:** ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and… more
- CVS Health (Baton Rouge, LA)
- …Required Qualifications + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience and skills in… more
