- Alameda Health System (Oakland, CA)
- …of utilization practices; assists physicians and hospital personnel in understanding UM matters. Perform all other duties as assigned. Prepares cost analysis ... Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff. Serves as a content expert to staff and… more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...contributes to performance improvement projects. + Remains current with clinical best practices and UM regulatory changes.… more
- CVS Health (Austin, TX)
- …while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include ... clinical setting with diverse cultural dynamics of clinical staff and patients. Registered Nurse (RN)...+ Requisition Job Description **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Elevance Health (Richmond, VA)
- …ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or ... that require the training and skill of a registered nurse . Acts as a resource for more junior Clinicians....management processes. + Assesses and applies medical policies and clinical guidelines within scope of licensure. These reviews may… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- Position Summary: The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates ... services rendered. Success in this role requires a strong balance of clinical knowledge, organizational skills, and effective communication. May perform other duties… more
- Blue KC (Workman, MN)
- …case management and clinical transplant experience + Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated ... Uses standardized tools to complete assessments in the areas of clinical , functional, financial, support system, psychosocial and cognitive and environmental realms.… more
- Evolent (Lansing, MI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… more
- University of Michigan (Ann Arbor, MI)
- CLINICAL NURSE SPECIALIST (CNS)- University Hospital- 4A-1 & 6B **Early Site Maintenance** We are performing updates and maintenance to our applicant experience. ... applications for job postings can not be submitted. Apply Now **Job Summary** The Clinical Nurse Specialist will be responsible for providing expert clinical … more
- Integra Partners (Troy, MI)
- … UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: ... + Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan...as criteria for medical necessity reviews + Work with non- clinical team to obtain additional clinical information,… more
- Truman Medical Centers (Kansas City, MO)
- …Schedule** 7:30AM - 4:00PM **Hours Per Week** 40 **Job Description** The Utilization Management Nurse ( UM RN) collaborates with members of the healthcare team to ... myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Mgmt Nurse RN - Care Continuity - UH Truman Medical Center… more
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in...with Standard Operating Procedures + Ensures accurate documentation of clinical decisions and works with UM Manager… more
- CVS Health (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to...+ Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams… more
- Saint Francis Health System (OK)
- …various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of ... weekend day Friday, Saturday, Sunday 7a-7p.** Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the review of… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE - University Hospital - Electroconvulsive Therapy (ECT)/ Ketamine Clinic **Early Site Maintenance** We are performing updates and maintenance to our ... $5.90 / hour + Night Shift Weekend Differential- $6.90 / hour + Charge Nurse Differential- $1.00 / hour The benefit package includes: + Excellent medical, dental and… more
- CVS Health (Lansing, MI)
- …for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria ... work. **Key Responsibilities** + Apply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring… more
- Katmai (Fort Carson, CO)
- …as a registered nurse in utilization management. + One (1) year of experience in UR/ UM and three (3) years of clinical nursing experience. + Must be able to ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the CMHS.… more
- University of Michigan (Ann Arbor, MI)
- …Survival Flight Initial Training Curriculum is to prepare the proficient emergency / critical care nurse for clinical practice as a Survival Flight Nurse at ... REGISTERED NURSE / FLIGHT NURSE SPECIALIST : University...Care, High Risk Obstetrics and Introductory Radiology and Diagnostics. Clinical education will also include Survival Flight Third-rider experience,… more
- Corewell Health (Grand Rapids, MI)
- …Friday (4 hours), mostly remote, occasional on-site About the Department: RN UM - Supporting the insurance coordination functions for the Helen DeVos Children's ... of insurance prior authorizations, initial reviews, continuous stay reviews and appeals. Nurse Care Manager - Plans and prioritizes care for individuals and… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE - Neonatal Nurse Practitioner Internship (Brandon NICU and Von Voigtlander Women's Hospital) **Early Site Maintenance** We are performing ... career opportunity for current registered nurses who have graduated from an accredited Nurse Practitioner program with a Neonatal Specialty. By teaching a wide range… more
