• Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would like in this… more
    US Tech Solutions (10/31/24)
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  • Utilization Management Nurse

    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 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
    LA Care Health Plan (11/09/24)
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  • Utilization Management Nurse

    CVS Health (Phoenix, AZ)
    …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is...Strong telephonic communication skills + 1+ years' experience with Microsoft… more
    CVS Health (11/24/24)
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  • Utilization Management Nurse

    CVS Health (Austin, TX)
    …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications: + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is...Strong telephonic communication skills + Experience with computers toggling between… more
    CVS Health (11/21/24)
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  • Utilization Management RN (mostly remote)

    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
    VNS Health (11/05/24)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    …Duties may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and ... experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and… more
    Ventura County (11/12/24)
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  • Registered Nurse -In Home Primary Care-…

    The Cigna Group (Houston, TX)
    …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
    The Cigna Group (11/22/24)
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  • Registered Nurse Case Manager

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... + A typical day would like in this role: Employee will be providing telephonic case management for our members. + Past job instability. Registered nurses MUST have… more
    US Tech Solutions (10/18/24)
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  • R&E Nurse - Med Care Services- Advanced

    Health Advocates Network (Harrisburg, PA)
    …setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An ... R&E Nurse - Med Care Services- Advanced **Pay Rate:** $28...(MA), health care services, human services, long term care, utilization review , or knowledge of home care… more
    Health Advocates Network (11/16/24)
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  • Registered Nurse - Outpatient

    ERP International (Scott AFB, IL)
    …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse (RN)** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL… more
    ERP International (09/28/24)
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  • Nurse Care Manager

    Spectrum Health Services (Philadelphia, PA)
    …from the hospital, specialty care practices, health plan staff, and others, the Nurse Care Manager identifies and proactively manages the needs of patients with high ... health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management basis appropriate… more
    Spectrum Health Services (09/19/24)
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  • Nurse Case Manager (Remote - Strong…

    Sedgwick Government Solutions (Orlando, FL)
    …experience + 3 years related clinical experience in discharge planning, oncology, utilization review /management to determine the necessity of medical services, ... be part of a highly skilled team of home-based ** Nurse Case Manager (NCM)s** providing telephonic case...of home-based ** Nurse Case Manager (NCM)s** providing telephonic case management, focused on supporting individuals in maximizing… more
    Sedgwick Government Solutions (11/26/24)
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  • Nurse Case Manager

    Nuvance Health (Poughkeepsie, NY)
    …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more
    Nuvance Health (11/26/24)
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  • Triage Nurse

    Actalent (Tampa, FL)
    …to established healthcare goals and care plans. + Use clinical expertise to review utilization information concerning patient care and match those needs to ... Exciting REMOTE Triage Nurse Opp for February 2025! The schedule will...an acute care setting to the home setting through telephonic outreach. You will provide education, coaching, and care… more
    Actalent (11/23/24)
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  • LPN or RN Nurse Case Manager (Onsite…

    The Cigna Group (Bloomfield, CT)
    …skills. + Typing and computer knowledge- able to type 35WPM. + Knowledge of utilization review requirements and procedures. + Knowledge of current health care ... weekly Complete Health Team rounds -market dependent. + Perform telephonic outreach. + Communicates with all departments to resolve...office. **Experience** : + Current Licensure as a registered nurse , in the state of residence in good standing.… more
    The Cigna Group (10/10/24)
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  • ACO Nurse Care Manager, Transitions of Care

    Baystate Health (Springfield, MA)
    …through face-to-face visits, home visits, if necessary, as well as telephonic interactions. In addition, they will assist with advance directives, palliative ... facility/program, emergency room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that is pending, ensure… more
    Baystate Health (09/04/24)
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  • Field Based Nurse Practitioner - Evernorth

    The Cigna Group (Nashville, TN)
    …with chronic illnesses in an effort improve clinical outcomes and decrease utilization . We provide physical, emotional, and spiritual support for patients who are ... facing life-threatening illnesses. We are currently seeking nurse practitioners who are passionate about serious illness care and management to join our growing… more
    The Cigna Group (10/19/24)
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  • Care Manager II Registered Nurse (BSN)…

    AmeriHealth Caritas (Greenville, SC)
    **Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Greenville, SC Primary Job Function: Medical Management ID**: 34482 **Job Brief** This ... position is a telephonic Care Manager, open to candidates in the SC...and evaluation of the effectiveness of the plan. + Review medication list and educate Members with pharmacy needs,… more
    AmeriHealth Caritas (11/23/24)
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  • REMOTE | Care Manager II Registered Nurse

    AmeriHealth Caritas (Florence, SC)
    **REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 **Job ... Brief** This position is a telephonic Care Manager that is required to reside in...and evaluation of the effectiveness of the plan. 2. Review medication list and educate Members with pharmacy needs,… more
    AmeriHealth Caritas (10/24/24)
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  • Senior UM Coordinator

    Brighton Health Plan Solutions, LLC (New York, NY)
    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...reviews. The Senior UM Coordinator reports to the Manager, Utilization Management and/or Supervisor, UM Coordinators. Primary Responsibilities +… more
    Brighton Health Plan Solutions, LLC (11/08/24)
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