- Matrix Providers (Aurora, CO)
- Registered Nurse ( RN ) - Utilization Management Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... is hiring a Registered Nurse ( RN ) - Utilization Management to...care clinical setting and 12 months consecutive experience in utilization management , utilization review… more
- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Utilization Managers** for full-time positions in support of theMike O'Callaghan ... Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... compliance with all local, state and federal regulations governing utilization review activities and/or care management...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... Diem RN (Adv CN)-Unit A4 position supports utilization review functions to ensure appropriate patient...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- Sharp HealthCare (San Diego, CA)
- … management experience + 3 Years recent case management , utilization review , care coordination experience + California Registered Nurse ( RN ) - ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe SRS RN… more
- CVS Health (Columbus, OH)
- …1 holiday per year).** There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is fully remote… more
- CVS Health (Harrisburg, PA)
- …of Saturday shift is approximately 1 per month.** No travel is required. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly...+ Behavioral Health professional with an active Massachusetts license: Registered Nurse , LICSW, LMHC + 3-5 years… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to.... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… 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 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- CVS Health (Carson City, NV)
- …all noncompact states. + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent review or prior ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted… more
- HCA Healthcare (Campbell, CA)
- …and personal growth, we encourage you to apply for our Utilization Management RN opening. We promptly review all applications. Highly qualified ... **Introduction** Do you have the career opportunities as a(an) ** Utilization Management RN ** you want...Nurse ** 's primary function is to ensure timely review of referral requests, procedures, and pre-certification requests in… more
- Trinity Health (Pontiac, MI)
- … RN licensure within the State of Michigan. Certified Professional in Utilization Review / Management preferred. **C** **Special Skill / Aptitudes** ... utilization management experience. Knowledge of regulations relative to utilization review . Knowledge of Federal, State and Local regulations sources.… more
- Cleveland Clinic (Vero Beach, FL)
- …stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, ... initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at...of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the...based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure… more
- CVS Health (Tallahassee, FL)
- …Must reside in Florida + Licensed Independent Behavioral Health clinician or an unrestricted Registered Nurse ( RN ) license in FL with psychiatric specialty ... convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity for candidates residing in… more