- Harbor Health Services, Inc. (Mattapan, MA)
- …improvements in quality and consistency of decisions. Supervisory responsibilities for UM RN , Quality Analyst, Appeals and Grievances Specialist. Requirements: ... and appropriateness of care within a managed care environment. Additionally, the Director of UM ...organization and serves as the organization's consultant regarding medical review process and UM regulations. Collaborates with… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on managed care and Medicaid policies and procedures… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** 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 ...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance… more
- Katmai (Fort Carson, CO)
- …Degree of Nursing. + Current, full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate from a college or university ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM )...years within the last four (4) years as a registered nurse in utilization management. + One… more
- ERP International (Luke AFB, AZ)
- **Overview** ERP International is seeking a full time ** Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ ... **Be the Best!** Join our team of exceptional health care professionals across the nation. Come discover the immense...full, active, and unrestricted license to practice as a Registered Nurse , any state. Clinical Certification:** Certified… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Alameda Health System (Oakland, CA)
- …background. Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California. Preferred Licenses/Certifications ... : Master's degree in Nursing Required Experience : Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute… 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...vital role in ensuring the delivery of high-quality, evidence-based care . This position is responsible for reviewing and evaluating… more
- Health Care Service Corporation (Helena, MT)
- …health needs within the scope of their benefit plan. **Required Job Qualifications:** + Registered Nurse ( RN ) with current, valid, unrestricted license to ... **Job Summary** This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning… more
- Healthfirst (NY)
- …concurrent review , and service requests Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers, ... institution or equivalent work experience NYS RN Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care … more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Cardiovascular Center- CVC 5, Cardiovascular Intensive Care Unit) Apply Now **Mission Statement** Michigan Medicine improves the health of ... Nurse Recruitment at ###. **Required Qualifications Current Michigan RN license. Two (2) year of moderate care...**Job Opening ID** 270506 **Working Title** REGISTERED NURSE (Cardiovascular Center- CVC 5, Cardiovascular Intensive Care … more
- University of Michigan (Ann Arbor, MI)
- …opportunity employer. **Job Detail** **Job Opening ID** 271747 **Working Title** REGISTERED NURSE - D. Dan and Betty Kahn Health Care Pavilion- PACU **Job ... REGISTERED NURSE - D. Dan and Betty...review charts for H&P, consent, etc.). Provide direct care for Pre-op patients. **Nursing Specific Info** Salary &… more
- Cedars-Sinai (Beverly Hills, CA)
- …the Los Angeles Fair Chance Initiative for Hiring. **Req ID** : 12949 **Working Title** : Registered Nurse - ISP Care Coordinator - PER_DIEM 8 Hour Days ... they are discharged from the hospital by assessing their needs, coordinating care , communicating with health plans, including concurrent review to determine… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... First Refusal (ROFR) requests, review of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE / FLIGHT NURSE SPECIALIST :...pediatric ICU (does not include Neonatal ICU) experience as a RN in a referral center / tertiary care ... Curriculum is to prepare the proficient emergency / critical care nurse for clinical practice as a...employer. **Job Detail** **Job Opening ID** 270230 **Working Title** REGISTERED NURSE / FLIGHT NURSE SPECIALIST… more
- US Tech Solutions (Wichita, KS)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior ... CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . +... Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
- Elevance Health (Washington, DC)
- …management specialists. + Manages resource utilization to ensure appropriate delivery of care to members, adequate coverage for all tasks and job responsibilities. + ... which would provide an equivalent background. **Preferred Qualifications** + Utilization review /utilization management experience is a must for this position. + A… more
- Molina Healthcare (Orem, UT)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as an Inpatient Authorization Review Services Registered Nurse or Licensed Practical Nurse -NICU ... difference. We are looking for a dedicated Inpatient Authorization Review Services Registered Nurse or... contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- Molina Healthcare (Sparks, NV)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...At least 2 years of experience with inpatient concurrent review , prior authorization and managed care ; Acute… more
