- LifePoint Health (Las Cruces, NM)
- …law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** *Registered Nurse (RN) Case Manager - UM - PRN (Remote)* **Location:** ... you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum...desirable. * Current New Mexico licensure as a Registered Nurse . * Certification as CCM or ACM desired. *_EEOC… more
- Integra Partners (Troy, MI)
- Integra Partners is seeking an experienced nurse educator to join our Operations Training & Development team as an Operations UM Training Specialist, ... a strong nursing background combined with expertise in clinical documentation, medical necessity determination, regulatory compliance, and will be responsible for… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Plan Solutions provides Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by performing data collection, data ... entry, and effectively communicating with Nurse reviewers and leaders' employers and claimants regarding their requests for preservice, prospective, and concurrent… more
- CVS Health (Albany, NY)
- …verbal and written **Required Qualifications** + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required + Must have active current ... our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k)… more
- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million ... external guidelines.** **Prepares and assigns cases/files to clinical staff ( Nurse , Social Worker, Care Navigator, Physician)** **.** **Responsibilities** + **Sends… more
- Centers Plan for Healthy Living (Jamaica, NY)
- UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435, USA Req #12129 Wednesday, November 13, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare ... and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who… more
- Magellan Health Services (Honolulu, HI)
- …services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. + Provides telephone triage, crisis intervention and ... of treatment when requests for services do not meet medical necessity criteria. + Participates in network development including...General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …a designated patient caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse , and other members of the treatment team, ACCESS center staff and ... concerns to the treatment team, Director of Utilization Management, and the Medical Director. + Review charts at identified review points and attend treatment… more
- LA Care Health Plan (Los Angeles, CA)
- …experience in a hospital or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group or management services organization. ... for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active,… more
- Molina Healthcare (Los Angeles, CA)
- …Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as ... well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- University of Miami (Coral Gables, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . NURSE ANESTHESIA FULL TIME FACULTY POSITION The ... University of Miami ( UM ) School of Nursing and Health Studies (SONHS) seeks...Nursing and Health Studies (SONHS) seeks qualified certified register nurse anesthetist (CRNA) faculty for full- time positions at… more
- University of Miami (Miami, FL)
- …sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of Miami/UHealth Medical Training Lab is currently seeking a ... full time Nurse Educator to work in Miami, FL. The ...a specialized area of nursing. The incumbent collaborates with medical practitioners to incorporate nursing processes into the plan… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : Ambulatory Care Services WAA- Medical Specialty Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations ... employer. **Job Detail** **Job Opening ID** 257150 **Working Title** REGISTERED NURSE : Ambulatory Care Services WAA- Medical Specialty **Job Title** REGISTERED… more
- CVS Health (Austin, TX)
- …shift requirement (Saturday and Sunday both) per the needs of the team.** The UM Nurse Consultant job duties include (not all encompassing): + Reviews services ... personal, convenient and affordable. **Position Summary:** This Utilization Management ( UM ) Nurse Consultant role is fully remote...to assure medical necessity, applies clinical expertise to assure appropriate benefit… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital ( Medical Short Stay Unit) Apply Now **How to Apply** This is a "multiple fill" job opening: A total of three (3) (0.9 FTE), ... action employer. **Job Detail** **Job Opening ID** 257250 **Working Title** REGISTERED NURSE : University Hospital ( Medical Short Stay Unit) **Job Title**… more
- Ventura County (Ventura, CA)
- Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management ... to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that… more
- University of Virginia (Charlottesville, VA)
- …of the healthcare team to promote and adhere to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All ... accordance with the mission vision and values of UVA Medical Center. + Analyze and evaluate complex medical...in interpretation of clinical data, and the application of UM tools. + Collaborates with physicians and care team:… more
- ERP International (Camp Pendleton, CA)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position supporting **Branch Health Clinic Port Hueneme, CA** in ... Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays!** Medical /Dental/Vision, STD/LTD/Life, and Health Savings Account available!** Annual CME Stipend and… more
- CVS Health (Harrisburg, PA)
- …state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): -Reviews ... personal, convenient and affordable. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote...services to assure medical necessity, applies clinical expertise to assure appropriate benefit… more