- State of Connecticut, Department of Administrative Services (Middletown, CT)
- …eligibility and documentation requirements (https://portal.ct.gov/DPH/Practitioner-Licensing--Investigations/ Registered - Nurse / RN -Licensure-by-Endorsement) ... Utilization Review Nurse Coordinator...application (https://www.elicense.ct.gov/) (expand the 'Public Health Practitioners' grouping, select ' Registered Nurse ' and then 'Start'; + Request… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $113,309.04 -… more
- CVS Health (Columbus, OH)
- …(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care - ... the following schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant, you will utilize clinical… more
- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Nurse ** **Location: Hospital Client ... vary and some flexibility may be offered** As our ** Utilization Review Nurse ** , you...other opportunities that promote growth. **Required Skills:** + Active Registered Nurse license For this US-based position,… 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...setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, member/family… more
- Milford Regional Medical Center (Milford, MA)
- …services to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization ... Minimum of 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual… more
- Humana (Columbus, OH)
- …Tuesday & Wednesday) **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in KY, IN, MI, OH, WV or Compact ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...to assist with social determinants and closing gaps + Review UM inpatient admission and clinical information to determine… more
- Humana (Des Moines, IA)
- …Provider calls **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in Illinois, Minnesota or Compact license ... independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge,… more
- CVS Health (Trenton, NJ)
- … RN licensure in state of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical experience in acute or post-acute setting + ... in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record… more
- CVS Health (Jefferson City, MO)
- … RN licensure in state of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical experience in acute or post-acute setting + ... in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with Electronic medical record… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …timely discharge between levels of care and facilities Essential Qualifications + Current licensed Registered Nurse ( RN ) in good standing. Must retain active ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- CVS Health (Baton Rouge, LA)
- …of training will require 100% participation Monday-Friday, 8am-5pm upon hire.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... Qualifications** + 5+ years of clinical experience + 1+ year(s) of utilization management, concurrent review and/or prior authorization experience + 5+… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer ...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- MetroHealth (Cleveland, OH)
- …patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is ... degree in Nursing (applies to placements after 1/1/2017). Current Registered Nurse License State of Ohio. Minimum...skills. Preferred: Two years of experience with case management, utilization review . Physical Demands: May need to… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer ...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Humana (Montgomery, AL)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse 2...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... constituents on CDPHP guidelines, policies, and procedures. QUALIFICATIONS + Registered Nurse or Licensed Practical Nurse...acute care experience is required as a Licensed Practical Nurse . + Minimum of two (2) years Utilization… more
- CVS Health (Chandler, AZ)
- …3 months. Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for ... innovators. **Fundamentals:** Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization ... workload in a fast-paced, rapidly changing regulatory environment. The Utilization Management RN works collaboratively with a.../ LICENSURE + Required: + Currently licensed as a Registered Professional Nurse in New York State.… more
- Cedars-Sinai (Los Angeles, CA)
- …thereafter as a condition of continued employment. **Req ID** : 4870 **Working Title** : Registered Nurse - Utilization Management 8 Hour Days Per Diem ... Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's...from an accredited nursing program required. Bachelors Degree in Nurse preferred. California RN License required. **Experience:**… more