- UPMC (Pittsburgh, PA)
- …Five years of experience in clinical, care coordination, and/or case management required. + Registered Nurse ( RN ) or Social Services Licensure (LSW, LCSW, ... Team. The team is looking to hire either an RN (as a Telephonic Care Manager) or...a clinical setting and case management nursing required. + Registered Nurse ( RN ) + .Meet… more
- The Cigna Group (Houston, TX)
- …and/or additional state licensure as needed 3) 3+ years of experience as a Registered Nurse with experience in internal medicine or adult medicine 4) Proficient ... The RN serves as the key contact point for...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing… more
- The Cigna Group (Baltimore, MD)
- …and/or additional state licensure as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with Microsoft Office applications, ... The RN Coordinator serves as the key contact point...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing… more
- ERP International (Scott AFB, IL)
- **Overview** ERP International is seeking a full time ** Registered Nurse ( RN )** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL ... a one-hour lunch between 11:00am and 1:00pm No Weekends, No Holidays, No Call! **Core Registered Nurse Duties:** The duties include, but are not limited to the… more
- ICW Group (Woodland Hills, CA)
- …providing direct clinical care required. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and...+ Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance… more
- Elevance Health (Atlanta, GA)
- ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... complete the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager II** is responsible for care management within… more
- Sharecare (Columbus, OH)
- …support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... Hours are on Central Standard Time. **Job Summary:** The RN has the responsibility for supporting the goals and...care enhancement program by ** ** providing high quality telephonic support in an appropriate, efficient and cost-effective manner… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Utilization Management Nurse Specialist RN...Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review ,… more
- 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 ... skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- CVS Health (Harrisburg, PA)
- …needs + Holiday rotation required **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... personal, convenient and affordable. Requisition Job Description **Position Summary:** **This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- CVS Health (Albany, NY)
- …9pm EST depending on business needs **Preferred Qualifications** - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the… more
- CVS Health (Tallahassee, FL)
- …+ Must live in Eastern time zone **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + Strong ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the… more
- Albany Medical Center (Albany, NY)
- …Work Shift: Day (United States of America) Salary range: $68,640 - $99,023 Registered Nurse - Full Time Neurosurgery Outpatient Office Work schedule: Monday ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's… more
- CVS Health (Des Moines, IA)
- …- Perform medical necessity reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting - A Registered Nurse that holds an active, unrestricted...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- CVS Health (Little Rock, AR)
- …medical necessity reviews **Required Qualifications** + 5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty + ... A Registered Nurse that holds an unrestricted license...lower levels of care + 1+ years' experience in Utilization Review + CCM and/or other URAC… more
- Northern Light Health (Pittsfield, ME)
- …various data to trace potential causes and relevant details. Credentials + Required Registered Nurse Education + Required Associate's Degree Working Conditions + ... to 4:30 pm Summary: The position's purpose is to assist and perform direct/ telephonic patient care as required for triage of calls, provider directives, protocols,… more
- CVS Health (Raleigh, NC)
- …care more personal, convenient and affordable. **Position Summary** **The Health Coach Consultant RN role is 100% remote work from home and candidates can reside in ... is full time, 40 hours/week, and remote for a RN with a compact license and acute Medical-Surgical Nursing...with an adult population. It requires proficiency in delivering telephonic coaching **and group coaching (via a web-based virtual… more
- CVS Health (Lansing, MI)
- …the case management system to organize cases dealing with disease management and utilization review ; tracks patient progress and manages specific conditions. + ... Qualifications** + Case Management experience in the insurance industry + Compact RN licensure + Certified Case Manager + Telephonic Nursing experience… more
- CVS Health (Miami, FL)
- …care more personal, convenient and affordable. **Summary** : The HIV/AIDS Care Manager RN is responsible for managing care management needs of FL Medicaid members ... care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to… more
- VNS Health (Manhattan, NY)
- …as assigned. Qualifications Licenses and Certifications:Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York ... subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is… more
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