- Actalent (Omaha, NE)
- …in medical review or utilization management. + Knowledge of utilization review , Medicare, utilization management, and EMR systems. Additional Skills ... Utilization Management NurseJob Description We are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …the healthcare continuum. Performs other duties as assigned. The ED-UM RN performs utilization review activities, ensuring appropriate level of care and status ... Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN)...on all patients reviewed in the ED. Conducts initial review using InterQual, and other tools, and assists provider… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a full-time remote Utilization Management Nurse Consultant opportunity. Utilization ... include weekends and holidays and evening rotations. As a Utilization Management Nurse Consultant, you will utilize...and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with… more
- Veterans Affairs, Veterans Health Administration (Johnson City, TN)
- Summary Position shared between Utilization Management (UM) and Accreditation. UM uses evidence-based practices to create guidance on admission, continued stay ... criteria and best clinical documentation to ensure efficient resource utilization . Accreditation deals with external quality assurance processes, inspections and… more
- Humana (Boise, ID)
- …interpretation and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...as needed by the business + This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr ... and UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience in ER, triage, ICU,… more
- CVS Health (Santa Fe, NM)
- …UM ( utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization. + 1+ years Managed Care (MCO) preferred. ... make health care more personal, convenient and affordable. **Position Summary** **100% remote position from anywhere in the US** **Work hours: 11:30am-8:00pm EST,… more
- Elevance Health (Tampa, FL)
- …managed care industry strongly preferred. + 2 years of experience in In-Patient, utilization review / management, evaluating medical necessity for services and ... RN Utilization Management Nurse Sr. (Medicaid-InPatient) JR130851...Tampa or Miami, FL offices. This is primarily a remote position but may be required to go in… more
- CVS Health (Charleston, WV)
- …care more personal, convenient and affordable. **Position Summary** This is a fully remote Utilization Management Nurse Consultant opportunity. The schedule ... EST time zone where the candidate resides. **.** Responsible for the review and evaluation of clinical information and documentation related to outpatient therapy… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Nurse (RN)** **$3,000 SIGN ON BONUS OFFERED** **Location** : Remote opportunity. Must reside in the state of Kentucky. The ** ... Utilization Management Nurse (RN)** is responsible to...are not limited to: + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- VNS Health (Manhattan, NY)
- …general supervision. Compensation Range:$98,200.00 - $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing ... Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with...and current registration to practice as a registered professional nurse in New York State Required Valid driver's license… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... basic computer skills is essential for excelling in this remote position. **Here's what you will experience working as...position. **Here's what you will experience working as a Utilization Review Author:** + Perform initial admission… more
- Centene Corporation (Madison, WI)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... benefits including a fresh perspective on workplace flexibility. **THIS POSITION IS REMOTE /WORK FROM HOME, WORK SCHEDULE WILL BE MONDAY-FRIDAY 8AM - 5PM DURING… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... including a fresh perspective on workplace flexibility. POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF FLORIDA...Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
- Hackensack Meridian Health (Neptune, NJ)
- …**Hackensack Meridian** **_Health_** includes: + Follows departmental workflows for utilization review activities including admission reviews, admission denials, ... leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team...New Jersey regulations for Nursing **.** **This is a remote , night shift position. The schedule for this role… more
- Sanford Health (MN)
- …dedicated to the work of health and healing across our broad footprint.** **Facility:** Remote MN **Location:** City - Remote MN, MN **Address:** **Shift:** 8 ... **Department Details** We are seeking a dedicated and detail-oriented Utilization Management Specialist RN to join our team. In...Management Specialist RN to join our team. In this remote position, you will play a crucial role in… more