- CVS Health (Tallahassee, FL)
- …affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization management is a 24/7 operation. Work ... verbal and written **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure in state of… more
- CVS Health (Hartford, CT)
- …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+ year(s) of clinical experience in acute or post acute setting **Preferred Qualifications** + Managed Care experience preferred **Education** + Associates Degree required + BSN preferred **Pay Range** The typical pay range for this… more
- LifePoint Health (Las Cruces, NM)
- …or local law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** *Registered Nurse (RN) Case Manager - UM - PRN (Remote)* **Location:** ... or InterQual is desirable. * Current New Mexico licensure as a Registered Nurse . * Certification as CCM or ACM desired. *_EEOC Statement_*: /Memorial Medical Center… more
- CVS Health (Phoenix, AZ)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + ... care more personal, convenient and affordable. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote and the candidate… more
- CVS Health (Austin, TX)
- …1 holiday per year).** There is no travel expected with this position. This UM Nurse Consultant position is part of Aetna's Commercial Care Management division ... health care more personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can… more
- System One (Baltimore, MD)
- …Management Nurse to support a leading health insurance customer. The UM Nurse will perform prospective, concurrent and retrospective reviews for ... or provider related administrative support. Qualifications Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire… more
- Omaha Children's Hospital (Omaha, NE)
- …regulatory requirements, payer issues, and benefits management. + Understands the NCM and UM Nurse role in revenue cycle management. + Collaborates with the ... policies. + Communicates and collaborates with the Utilization Management ( UM ) Nurse , or other NCMs as necessary... UM Nurse to identify and document Avoidable... UM Nurse to identify and document Avoidable Days according to… more
- Stanford Health Care (Palo Alto, CA)
- …a remote Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be responsible for ensuring the efficient and ... Care (SHC)? Here is your opportunity to work with the unique and supportive UM team. You can put your knowledge about Medicare, Medi-Cal, Medicaid, and bedside RN… 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, ... and facilitation of the Operations training and development program. The Operations UM Training Specialist will work in collaboration with Operations leadership and… 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
- 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)
- …influence quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required Clinical Work ... - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred… more
- Medical Mutual of Ohio (OH)
- …external guidelines.** **Prepares and assigns cases/files to clinical staff ( Nurse , Social Worker, Care Navigator, Physician)** **.** **Responsibilities** + **Sends ... perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Services Support Specialist (Medicare UM )_ **Location:** _Ohio_ **Requisition ID:**… 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 ... Degree **Licenses and Certifications Preferred:** + NJ State Professional Registered Nurse License or NJ Licensed Social Worker **Job ID** _2024-150722_… more
- LA Care Health Plan (Los Angeles, CA)
- …for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department:...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for… more
- University of Michigan (Ann Arbor, MI)
- …Time** Part-Time **Regular/Temporary** Regular **FLSA Status** Nonexempt **Organizational Group** Um Hospital **Department** MM Mich Visiting Nurse Assoc ... LICENSED PRACTICAL NURSE (Michigan Visiting Nurse ) Apply Now **Mission Statement** The University of Michigan Health System improves the health of patients,… 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)
- …. The University of Miami/UHealth Medical Training Lab is currently seeking a full time Nurse Educator to work in Miami, FL. The Nurse Educator provides clinical ... programs utilizing advanced technologies and simulation systems. The Simulation Nurse Educator develops curricula and provides training and facilitates… more