- NJM Insurance (Trenton, NJ)
- …departmental business process improvements. Required Skills & Experience: + Actively licensed registered Nurse in New Jersey and Connecticut, Delaware, Maryland, ... uphold, modify, or overturn prior decisions. + Conduct Inpatient Care utilization review using NJM and evidence-based clinical guidelines to ensure appropriate… more
- G-TECH Services, Inc. (Detroit, MI)
- …experience in an acute care setting Education/Certifications - Include: * Must be a RN with an unrestricted Registered Nurse license **Category** _Benefits_ ... (1) year health insurance plan experience or managed care environment highly preferred. Registered Nurse with current unrestricted Michigan Registered … more
- Trinity Health (Albany, NY)
- …other related duties as assigned Experience and Requirements + Active Licensure as a registered nurse , preferably with a **bachelor's degree** in nursing from an ... Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals...accredited school and Certified Registered Rehab Nurse preferred (CRRN). + A… more
- Baptist Memorial (Memphis, TN)
- …Lead Facility: BMH - Women's Hospital Department: WH Case Management Admin BMH Women's Category: Nurse RN Type: Clinical Work Type: Full Time Work Schedule: ... situation. Performs other duties as assigned. Responsibilities + Utilization Review and precertification + Discharge planning +...Minimum: Diploma or Associate Degree in Nursing Experience Preferred: RN with 5 years of clinical experience… more
- Houston Methodist (Baytown, TX)
- …performance that demonstrates progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure ... + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and Appeals. Collaborates...and/or Compact State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- International Medical Group (Indianapolis, IN)
- …or tasks as assigned. QUALIFICATIONS + Current and active Nursing license - Registered Nurse + Minimum two years acute hospital-based experience providing direct ... creating the best experience for travelers. JOB DETAILS + RN License -- Must have an active RN...of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between… more
- Katmai (Usaf Academy, CO)
- …for inpatient/outpatient precertification . **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to ... the Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. +...+ Must possess a current, active, full, and unrestricted Registered Nurses ( RN ) licensed in Colorado, be… more
- CVS Health (Sacramento, CA)
- …state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job...in PST preferred + 1+ years experience in either Precertification or Utilization Review highly preferred +… more
- CVS Health (Olympia, WA)
- …year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all… more
- Elevance Health (Tampa, FL)
- …medical policy, and member eligibility, benefits, and contracts. + Conducts precertification , continued stay review , care coordination, or discharge planning ... Job Description ** Nurse Medical Management Sr.** **Preferred Location** : Florida....**How will you make an impact:** + Continued stay review , care coordination, and discharge planning for appropriateness of… more