- Commonwealth Care Alliance (Boston, MA)
- …**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 Nurse Utilization Management Reviewer has a key role in… more
- Somatus (Tucson, AZ)
- …utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management ... telephonically as the need arises. **This is a fully remote role where compact licensure is strongly preferred.** **The...Uses protocols and pathways in line with established disease management and care management programs and approved… more
- Battelle Memorial Institute (Tampa, FL)
- …two years' nursing experience + Current, full, active, and unrestricted license as a Registered Nurse in any US State, the District of Columbia, Guam, Puerto ... as a case manager by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center + At least… more
- Parexel (Juneau, AK)
- …Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- Teleflex (Buffalo, NY)
- …based Sales Representative, Anesthesia, is making connections with anesthesiologists, Certified Registered Nurse Anesthetist's (CRNA's), other members of the ... our world-class brands including: + LMA and Rusch airway management devices designed to help reduce the risk of...business plan. - Grow overall market share and increase utilization among existing accounts, while securing new users within… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... and phone calls Working Conditions: - This is a remote or hybrid role with the expectation of working...& Language (nice to have): - Familiarity with care management and utilization management systems… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- Actalent (Minnetonka, MN)
- Remote Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for ... necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review....+ Proficiency in prior authorization processes. + Active, unrestricted RN license in the state of MN or WI.… more
- CVS Health (Phoenix, AZ)
- …a meaningful difference in the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part of a mission-driven team that's ... Monday-Friday 8:00am-5:00pm AZT (No weekends or holidays) Location: 100% Remote (Must have Arizona RN license or...in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims… more
- CVS Health (Phoenix, AZ)
- …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 ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- CVS Health (Lansing, MI)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, ... initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Ascension Health (St. Charles, IL)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... **Details** + **Department:** Utilization Review + **Schedule:** Part-Time, Partially Remote.../ Registration: + Registered Nurse credentialed from the Illinois Board… more
- CVS Health (Austin, TX)
- …+ Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in ... with diverse cultural dynamics of clinical staff and patients. Registered Nurse ( RN ) required. Licensed...late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you… more
- ChenMed (St. Louis, MO)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional ... and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the… more
- Ochsner Health (New Orleans, LA)
- …discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager - Case Management OMC Jefferson Highway PRN To perform ... experience in discharge planning, case management or utilization review. **Certifications** Required - Current registered ...or utilization review. **Certifications** Required - Current registered nurse license in state of practice.… more
- AccentCare, Inc. (Middlebury, CT)
- …Hospice Location: Middlebury, CT Position: Admissions Registered Nurse / RN , Hospice Position Type: Part Time Remote /Virtual Position: No Coverage Area: ... Overview Admissions Registered Nurse / RN ,...and external partners, ensuring timely updates, interventions, and resource utilization + Provide patient and caregiver education, document care… more
- Banner Health (Phoenix, AZ)
- …of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in an ... , acute care and/or home care environments, community resources and resource/ utilization management . Must demonstrate critical thinking skills, problem-solving… more
- Bon Secours Mercy Health (Norfolk, VA)
- …clinical and operational excellence. **Summary of Primary Function** In the capacity of a Registered Nurse ( RN ), the Ambulatory Care Manager will provide ... clinical care management services to identified eligible patients; coordinating care to...Nursing Bachelor's Degree (preferred) Specialty/Major- Nursing (BSN) **Licensing/ Certification** Registered Nurse with active License in State… more
- Geisinger (Danville, PA)
- …Specialty Training Program-Nursing (Required) Experience Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania; ... Job Summary Geisinger is proud to offer a full time Inpatient RN up to $24,000 hiring incentive for eligible candidates! $41 minimum hiring rate with increased rates… more
