- 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 ... 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
- Somatus (Utica, NY)
- …utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management ... telephonically as the need arises. **This is a fully remote role where New York licensure is required.** **The...Uses protocols and pathways in line with established disease management and care management programs and approved… more
- Commonwealth Care Alliance (Springfield, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... programing is responsible for providing care delivery and care management to a specific panel of high risk and...Supervision Exercised: Yes - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- BlueCross BlueShield of Tennessee (Memphis, TN)
- …this position\. + This job requires digital literacy assessment\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... have you on our team\. **Job Responsibilities** + Supporting utilization management functions for more complex and...their residence if the state is participating in the Nurse Licensure Compact Law\. _Experience_ + 3 years \-… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... Manager will collaborate closely with other members of the management team. This role is full-time on site in...role. Supervision Exercised: - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- Teleflex (Tampa, FL)
- …based Sales Representative, Anesthesia, is making connections with anesthesiologists, Certified Registered Nurse Anesthetist's (CRNA's), other members of the ... our world-class brands including: + LMA and Rusch airway management devices designed to help reduce the risk of...business plan. - Grow overall market share and increase utilization among existing accounts, while securing new users within… more
- Parexel (Oklahoma City, OK)
- …Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... overall member experience. **Working Conditions:** + This is a remote or hyrbrid role with the expectation of working...& Language (nice to have):** + Familiarity with care management and utilization management systems… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... and phone calls Working Conditions: - This is a remote or hybrid role with the expectation of working...& Language (nice to have): - Familiarity with care management and utilization management systems… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- SR International, Inc. (Phoenix, AZ)
- …their own laptop SOAZ - Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote /Onsite Trainings) Skills Required: *Medical nursing practice, medical ... times for training once starting position Compliance Items: Active RN License in state of Arizona Fingerprint Clearance Card...case management protocols, quality management and … more
- Commonwealth Care Alliance (Boston, MA)
- 011330 CCA-Clin Operations & Implementation **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... and presents results. + Develops and analyzes quantitative reports to assess utilization , productivity and adherence to policies and procedures related to various… more
- Actalent (Santa Barbara, CA)
- …Nurse Coordinator - REMOTE POSITION Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a ... 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote...Health Plan Nurse Coordinator (HPNC) is a Registered Nurse assigned to one of several… more
- Cognizant (Carson City, NV)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Molina Healthcare (GA)
- …experience. * At least 1 year of health care management /leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
- CVS Health (Little Rock, AR)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... needed. + 3+ years inpatient clinical experience as a Registered Nurse . + 3+ years of Managed...years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership… more
- Molina Healthcare (GA)
- …and experience. * At least 3 years health care management /leadership required. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
- Tufts Medicine (Burlington, MA)
- …of Science in Nursing (BSN). 2. RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case ... review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization … more
