- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would like in this… 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 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- CVS Health (Phoenix, AZ)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is...Strong telephonic communication skills + 1+ years' experience with Microsoft… more
- CVS Health (Austin, TX)
- …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications: + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is...Strong telephonic communication skills + Experience with computers toggling between… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… more
- Ventura County (Ventura, CA)
- …Duties may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and ... experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and… more
- The Cigna Group (Houston, TX)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... + A typical day would like in this role: Employee will be providing telephonic case management for our members. + Past job instability. Registered nurses MUST have… more
- Health Advocates Network (Harrisburg, PA)
- …setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An ... R&E Nurse - Med Care Services- Advanced **Pay Rate:** $28...(MA), health care services, human services, long term care, utilization review , or knowledge of home care… more
- ERP International (Scott AFB, IL)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse (RN)** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL… more
- Spectrum Health Services (Philadelphia, PA)
- …from the hospital, specialty care practices, health plan staff, and others, the Nurse Care Manager identifies and proactively manages the needs of patients with high ... health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management basis appropriate… more
- Sedgwick Government Solutions (Orlando, FL)
- …experience + 3 years related clinical experience in discharge planning, oncology, utilization review /management to determine the necessity of medical services, ... be part of a highly skilled team of home-based ** Nurse Case Manager (NCM)s** providing telephonic case...of home-based ** Nurse Case Manager (NCM)s** providing telephonic case management, focused on supporting individuals in maximizing… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more
- Actalent (Tampa, FL)
- …to established healthcare goals and care plans. + Use clinical expertise to review utilization information concerning patient care and match those needs to ... Exciting REMOTE Triage Nurse Opp for February 2025! The schedule will...an acute care setting to the home setting through telephonic outreach. You will provide education, coaching, and care… more
- The Cigna Group (Bloomfield, CT)
- …skills. + Typing and computer knowledge- able to type 35WPM. + Knowledge of utilization review requirements and procedures. + Knowledge of current health care ... weekly Complete Health Team rounds -market dependent. + Perform telephonic outreach. + Communicates with all departments to resolve...office. **Experience** : + Current Licensure as a registered nurse , in the state of residence in good standing.… more
- Baystate Health (Springfield, MA)
- …through face-to-face visits, home visits, if necessary, as well as telephonic interactions. In addition, they will assist with advance directives, palliative ... facility/program, emergency room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that is pending, ensure… more
- The Cigna Group (Nashville, TN)
- …with chronic illnesses in an effort improve clinical outcomes and decrease utilization . We provide physical, emotional, and spiritual support for patients who are ... facing life-threatening illnesses. We are currently seeking nurse practitioners who are passionate about serious illness care and management to join our growing… more
- AmeriHealth Caritas (Greenville, SC)
- **Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Greenville, SC Primary Job Function: Medical Management ID**: 34482 **Job Brief** This ... position is a telephonic Care Manager, open to candidates in the SC...and evaluation of the effectiveness of the plan. + Review medication list and educate Members with pharmacy needs,… more
- AmeriHealth Caritas (Florence, SC)
- **REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 **Job ... Brief** This position is a telephonic Care Manager that is required to reside in...and evaluation of the effectiveness of the plan. 2. Review medication list and educate Members with pharmacy needs,… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by performing data collection, data entry, and ... effectively communicating with Nurse reviewers and leaders' employers and claimants regarding their...reviews. The Senior UM Coordinator reports to the Manager, Utilization Management and/or Supervisor, UM Coordinators. Primary Responsibilities +… more
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