- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Utilization Managers** for full-time positions in support of theMike O'Callaghan ... Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... compliance with all local, state and federal regulations governing utilization review activities and/or care management...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- Centene Corporation (Madison, WI)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review , and retrospective… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... Diem RN (Adv CN)-Unit A4 position supports utilization review functions to ensure appropriate patient...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- CVS Health (Columbus, OH)
- …and affordable. **Primary Job Duties & Responsibilities** + Drives effective utilization management practices by ensuring appropriate and cost-effective ... use of healthcare resources. + Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare… more
- Sharp HealthCare (San Diego, CA)
- … management experience + 3 Years recent case management , utilization review , care coordination experience + California Registered Nurse ( RN ) - ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe SRS RN… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has...standard Utilization Review processes. The Utilization Management RN is an ... workload in a fast-paced, rapidly changing regulatory environment. The Utilization Management RN works collaboratively.../ LICENSURE + Required: + Currently licensed as a Registered Professional Nurse in New York State.… more
- CVS Health (Austin, TX)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote… more
- CVS Health (Phoenix, AZ)
- …occasionally per the need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly...+ Behavioral Health professional with an active Massachusetts license: Registered Nurse , LICSW, LMHC + 3-5 years… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to.... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… more
- CVS Health (Tallahassee, FL)
- …may include weekends and holidays and evening rotations. This is a full-time remote Utilization Management Nurse Consultant opportunity. As a Utilization ... health care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Commonwealth Care Alliance (Boston, MA)
- … Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization ... Bachelor's Degree in Nursing Required Licensing (must have): * RN with an active registered nursing license...Massachusetts. . Required Experience (must have): * 3-5 years utilization management experience * 3+ years' experience… more
- Trinity Health (Pontiac, MI)
- … RN licensure within the State of Michigan. Certified Professional in Utilization Review / Management preferred. **C** **Special Skill / Aptitudes** ... utilization management experience. Knowledge of regulations relative to utilization review . Knowledge of Federal, State and Local regulations sources.… more
- Cleveland Clinic (Vero Beach, FL)
- …stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, ... initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at...of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the...based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure… more
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