- Alameda Health System (Oakland, CA)
- …of utilization practices; assists physicians and hospital personnel in understanding UM matters. Perform all other duties as assigned. Prepares cost analysis ... Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff. Serves as a content expert to staff and… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This ... clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and… more
- Integra Partners (Troy, MI)
- … UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: ... + Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan...Performs other duties as assigned EDUCATION: Active, Licensed Vocational Nurse , or Licensed Practical Nurse license EXPERIENCE:… more
- CVS Health (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity of care and… more
- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + ... (LCSW) preferred. + Requisition Job Description **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote and the candidate… more
- CVS Health (Columbus, OH)
- …in the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Medical Review, you'll play a vital ... Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and… more
- Saint Francis Health System (OK)
- …various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of related experience in… more
- Truman Medical Centers (Kansas City, MO)
- …Schedule** 7:30AM - 4:00PM **Hours Per Week** 40 **Job Description** The Utilization Management Nurse ( UM RN) collaborates with members of the healthcare team to ... myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Mgmt Nurse RN - Care Continuity - UH Truman Medical Center… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- Position Summary: The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates ... other duties as assigned. Required Qualifications: Valid license as a Licensed Vocational Nurse issued by the State of California. High school diploma or equivalent… more
- Elevance Health (Richmond, VA)
- …relatively complex case types that require the training and skill of a registered nurse . Acts as a resource for more junior Clinicians. **Primary duties may include ... but are not limited to** **:** + Responsible for complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear. + Serves as a resource to lower-level clinicians and staff. + May collaborate with leadership to… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine… more
- LA Care Health Plan (Los Angeles, CA)
- …for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (Adult Emergency Services) **Early Site Maintenance** We are performing updates and maintenance to our applicant experience. As ... Night Shift Weekend Differential- $6.90 / hour + Charge Nurse Differential- $1.00 / hour What Benefits can you...no-cost CEs and professional development for advancement **Responsibilities The UM Adult ED is a Level 1 Trauma Center… more
- Blue KC (Workman, MN)
- …standards. Documents transplant authorization, issues authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. ... Associate degree in nursing + Valid and active Registered nurse (RN) in Missouri and Kansas. + 3 years...level keyboarding skills + Intermediate level knowledge of FACETS UM , CM and claims applications. + Experience in working… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE - University Hospital - Electroconvulsive Therapy (ECT)/ Ketamine Clinic **Early Site Maintenance** We are performing updates and maintenance to our ... $5.90 / hour + Night Shift Weekend Differential- $6.90 / hour + Charge Nurse Differential- $1.00 / hour The benefit package includes: + Excellent medical, dental and… more
- Evolent (Lansing, MI)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- CVS Health (Lansing, MI)
- …for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to ... of a computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the CMHS. ... active, and unrestricted license to practice as a registered nurse . + Must be a graduate from a college...utilization management. + One (1) year of experience in UR/ UM and three (3) years of clinical nursing experience.… more
- Katmai (Fort Carson, CO)
- …and record data. + Facilitate the development and integration of utilization management ( UM ) review policies and procedures into operations. + Perform Right of First ... last two (2) years as a practical or vocational nurse . + Current, full, active, and unrestricted license as...Cross. + Must understand the principles of UR and UM and be able to apply knowledge in processing… more
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