- Martin's Point Health Care (Portland, ME)
- …preferred + 3+ years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting + ... The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas...Required License(s) and/or Certification(s): + Current Licensure as an RN in Maine and other appropriate jurisdictions as necessary… more
- Actalent (San Antonio, TX)
- …complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and ... Immediate Hiring for " Remote Clinical Review Nurses" Job Description:...discharge planning is must + Active RN Compact License is Must If you are Interested… more
- CVS Health (Frankfort, KY)
- …it all with heart, each and every day. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant. **Must reside in the state of ... Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse ( RN ) with active...schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population… more
- Dartmouth Health (Lebanon, NH)
- …communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote * Area ... of Interest:Nursing * Pay Range:$79,747.20/Yr. - $127,587.20/Yr. (Based on 40 hours per week, otherwise pro rata) * FTE/Hours per pay period:.01 hrs/per week (per diem/temp) * Shift:Rotating * Job ID:35880 Dartmouth Health offers a total compensation package… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or… more
- Trinity Health (Columbus, OH)
- …of clinical nursing experience with at least 2 years experience in utilization review , discharge planning, case management, or disease management experience ... respond to common symptoms they might experience. + Coordinates with the utilization review , case management, discharge planning staff within network facilities.… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Bon Secours Mercy Health (SC)
- …clinical and operational excellence. **Summary of Primary Function** In the capacity of a Registered Nurse ( RN ), the Ambulatory Care Manager will provide ... a plan of care to ensure medically appropriate cost-effective care. This is a remote /work at home position. Hire must be open to working eastern time zone hours… more
- CVS Health (Austin, TX)
- … states. This role is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for telephonically and/or face ... National Medical Excellence (NME) team and is a fully remote position. Candidates from any state are welcome to...residence - 5 years clinical practice experience as an RN - 6+ months Case Management or Utilization… more
- CVS Health (Topeka, KS)
- …+ 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
- TEKsystems (Jackson, MS)
- …8 AM-5 PM CST Quality Assurance Responsibilities: + Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews. ... and specifications are followed and all questions addressed. + Verify each review is supported by current clinical citations and references from reputable medical… more
- MyFlorida (Sanford, FL)
- OPS REGISTERED NURSE - 64858505 Date: Jan 7,...Seminole County 400 W. Airport Blvd Sanford, FL 32773 Remote work will not be a consideration . The Florida ... . Requisition No: 865084 Agency: Department of Health Working Title: OPS REGISTERED NURSE - 64858505 Pay Plan: Temp Position Number: 64858505… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness...State of PA RN licensure OR Current… more
- Humana (Jackson, MS)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- US Tech Solutions (Columbia, SC)
- …the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech ... be onsite for at least the 1-2 weeks and then will go remote . **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and… more
- Penn Medicine (Lancaster, PA)
- …Other duties as assigned. **Minimum Required Qualifications:** + Current licensure as a Registered Nurse , issued by the Pennsylvania Board of Nursing + ... day. Are you living your life's work? **LOCATION:** Fully remote position after 12-week onsite orientation **HOURS:** Full Time...Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist… more
- CVS Health (Baton Rouge, LA)
- …Responsibilities** + Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + ... do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to… more
- CVS Health (Phoenix, AZ)
- …Information** Schedule: Monday-Friday 8:00am-5:00pm AZT (No weekends or holidays) Location: 100% Remote (Must have Arizona RN license or compact license that ... + Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . ** Remote Work Expectations** + This is a 100% … more
- Centene Corporation (Springfield, IL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- CVS Health (Phoenix, AZ)
- …for 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....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
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