- CVS Health (Columbus, OH)
- …anywhere in the US Work hours: 8:30am-5:00pm EST, Monday-Friday. This position is for a UM nurse consultant who will be joining our reconsideration team. A ... reconsideration nurse will review any additional information submitted within the...management function. Required Qualifications + 1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent… more
- CVS Health (Salem, OR)
- …will occasionally be required.Required Qualifications 1 year of varied UM (utilization management) experience within an inpatient/outpatient setting, concurrent ... ability to make thorough, independent decisions using clinical judgement. A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- CVS Health (Hartford, CT)
- …both verbal and written Required Qualifications- 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN licensure in state of ... residence- Must possess 1+ years of clinical experience in acute or post-acute setting -Must be available to work Monday through Friday from 8 AM to 5 PM in resident time zone -Some weekends and holidays will be required Preferred Qualifications- 3+ years of… more
- CVS Health (Lansing, MI)
- …This role is Telework anywhere! Preference for MI residents. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for ... services requiring precertification. The majority of the time is spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical… more
- CVS Health (Montgomery, AL)
- …This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our ... purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors (TM) support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming… more
- CVS Health (Raleigh, NC)
- …(typically 1 holiday per year). There is no travel expected with this position. This UM Nurse Consultant position is part of Aetna's Commercial Care ... regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): -Reviews… more
- CVS Health (Columbus, OH)
- …9:30am-6:00 pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a ... to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can live in… more
- CVS Health (Richmond, VA)
- … role is fully remote and employee can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process ... Experience Medicare/Medicaid populations - MCG experience - Managed care experience - UM Certification - MedCompass - 1+ year(s) of inpatient utilization experience… more
- CVS Health (Columbus, OH)
- …health care more personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee ... Eastern Standard Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process to assess,… more
- CVS Health (Columbus, OH)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): ... to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can live in… more
- CVS Health (Plantation, FL)
- …Monday-Friday; 10:00 AM- 6:30 PM EST No nights, no weekends, and no holidays. The UM Nurse Consultant job duties include (not all encompassing): -Reviews ... Spanish highly preferred + Compact RN License or license in multiple states + UM Nurse Consultant experience + Experience with overseas access to care +… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary Duals UM Nurse Consultant Pennsylvania - Institutional Special Needs Plan ... - Utilization Review experience preferred - Managed care experience - UM /CM/MCG Certification - Med Compass Experience Education Associates Degree required BSN… more
- Kepro (Richmond, VA)
- …a vital partner for health solutions in the public sector. Acentra seeks a UM Reviewer & Appeals Coordinator RN/LCSW (Remote within Virginia) to join our growing ... role in managing and coordinating the clinical appeals process with our client. UM Clinical Reviewer: + Using clinical knowledge and nursing experience, to review… more
- Kepro (Richmond, VA)
- …partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer RN to join our growing team. Job Summary: Our Clinical ... for services. + Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing; Master's Degree; Certified ... to identify areas of risk and act as a consultant to the facility based ICM leaders to develop...Years Acute Care Case Management experience. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred… more
- CVS Health (Phoenix, AZ)
- …to work on Arizona time zone. No weekends, holidays are required. The UM Clinical Consultant utilizes clinical skills to coordinate, document and communicate ... all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. Consults and lends expertise to… more
- CVS Health (Phoenix, AZ)
- …information from providers. Required Qualifications + 1+ year: Oncology and Transplant UM , concurrent review or prior authorization + 3+ years: acute clinical ... training required 100% participation during 8:30am-5pm Monday-Friday EST. + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- CVS Health (Columbus, OH)
- …Medicare/Medicaid - Managed care (MCO) experience - Med Compass experience - CM/ UM Certification Education Associates Degree required BSN preferred Pay Range The ... typical pay range for this role is: $29.10 - $62.31 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of… more
- Immigration and Customs Enforcement (IN)
- …Healthcare Compliance, Office of Health Plan Management. The Senior Utilization Review Consultant will report directly to the IHSC Regional Utilization Manager with ... DUTIES AND RESPONSIBILITIES: Serves in the capacity of Senior Utilization Review Consultant and subject matter expert in program activities and policies related to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual contributor while collaborating ... + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria and accreditation and regulatory criteria… more