- CVS Health (Columbus, OH)
- …work the following schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant, you will utilize ... (Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care -… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… 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 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Des Moines, IA)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Baton Rouge, LA)
- …of training will require 100% participation Monday-Friday, 8am-5pm upon hire.** As a Utilization Management Nurse Consultant, you will utilize clinical ... Qualifications** + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + 5+ years… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record… more
- CVS Health (Jefferson City, MO)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with Electronic medical record… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse ...knowledge and is proficient with standard Utilization Review processes. The Utilization Management ... their appropriate admission status. This individual will support the Utilization Management process by maintaining effective and...+ Required: + Currently licensed as a Registered Professional Nurse in New York State. + Associates Degree +… more
- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance ... License for the state the consultant resides in - 4-5 years of Remote Utilization Management experience at Payors, inpatient or outpatient - Proficiency using a… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer ...submit to the department's Quality Assurance Team and UM Management . Duties Facilitates the development, review , and… more
- Cedars-Sinai (Los Angeles, CA)
- …as a condition of continued employment. **Req ID** : 4870 **Working Title** : Registered Nurse - Utilization Management 8 Hour Days Per Diem **Department** : ... Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's... Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category**… more
- AdventHealth (Daytona Beach, FL)
- …Medical Parkway, Daytona Beach, FL 32117 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical ... reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. +… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Actalent (Rancho Cordova, CA)
- …indicated, timely verbal and written documentation, and completion of the file Skills: Utilization review , Case management , Acute care, Prior authorization, ... Five or more year's clinical experience required. Three to five years Utilization Management experience required. One to three years charge/lead/supervisory/… more
- CVS Health (New Albany, OH)
- …3 months. Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for ... telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to… more
- Conviva (Austin, TX)
- …+ Prior clinical experience, managed care experience, Home Health, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Elevance Health (Columbus, OH)
- Nurse Utilization / Medical Management I - Medicaid (JR129062) **Location:** Candidates must reside within 50 miles or 1-hour commute each way of one of our ... Friday, 8am - 5pm. EAST COAST WORK HOURS. The ** Nurse Medical Management l** is responsible to...2 years acute care clinical experience. **Preferred Qualifications:** + Utilization Management / Review experience within managed… more
- University of Rochester (Rochester, NY)
- Responsibilities **General Description:** The Utilization Management Nurse role is a unique and exciting opportunity that blends the knowledge of nursing and ... hospital experience required or equivalent combination of health care experience. + Utilization Management experience preferred. + Experience with databases such… more