- LifePoint Health (Las Cruces, NM)
- …law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** *Registered Nurse (RN) Case Manager - UM - PRN (Remote)* **Location:** ... are appreciated for who you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum of care, including diagnostic,… more
- Integra Partners (Troy, MI)
- … educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. ... network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We are reimagining access to in-home healthcare to improve the… more
- CVS Health (Tallahassee, FL)
- …convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization management is a ... constituents in the coordination and administration of the utilization/benefit management function. + Typical office working environment with productivity and… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role Brighton Health Plan Solutions provides Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by ... regarding their requests for preservice, prospective, and concurrent reviews. The Senior UM Coordinator reports to the Manager, Utilization Management and/or… more
- CVS Health (Hartford, CT)
- …constituents in the coordination and administration of the utilization/benefit management function. + Typical office working environment with productivity and ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million ... administrative functions in support of assigned utilization review or case management department. Receives and reviews correspondence from various internal and… more
- Centers Plan for Healthy Living (Jamaica, NY)
- …the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and ... UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435,...home to improve their quality of life. The Utilization Management nurse will assess and process all… more
- Magellan Health Services (Honolulu, HI)
- …services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. + Provides telephone triage, crisis intervention and ... alternative plans of treatment when requests for services do not meet medical necessity criteria. + Participates in network development including identification and… 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 ... UM Clinical Reviewer 5297 W Copans Rd, Margate,...their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director. + Review charts at identified ... and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral health resource… more
- LA Care Health Plan (Los Angeles, CA)
- …. Preferred: Managed Care experience performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, ... Utilization Management Nurse Specialist RN II Job...requests by Providers. Acts as a department resource for medical service requests /referral management and processes.… more
- Ventura County (Ventura, CA)
- Senior Medical Management Nurse -...is currently one (1) Full-Time Regular vacancy in Utilization Management ( UM ) with the Ventura County Health ... VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management Nurse - VCHCP Salary $109,675.03 -… more
- University of Virginia (Charlottesville, VA)
- …compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in ... Under general direction: The Utilization Management RN serves as a leader resource in...accordance with the mission vision and values of UVA Medical Center. + Analyze and evaluate complex medical… more
- CVS Health (Phoenix, AZ)
- …to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote and ... the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical...turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not… more
- CVS Health (Austin, TX)
- …to make health care more personal, convenient and affordable. Position Summary: This Utilization Management ( UM ) Nurse Consultant role is fully remote and ... There is no travel expected with this position. This UM Nurse Consultant position is part of...supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical… more
- Molina Healthcare (Los Angeles, CA)
- …Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as ... well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- University of Miami (Miami, FL)
- …time management , and critical thinking skills development. + Collaborates with medical providers, patient care staff, and unit management in the planning, ... this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of Miami/UHealth Medical Training Lab is currently seeking a full time… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : Ambulatory Care Services WAA- Medical Specialty Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations ... float nurse BSN Experience as a charge nurse or equivalent management skills Proficiency with...**Job Detail** **Job Opening ID** 257150 **Working Title** REGISTERED NURSE : Ambulatory Care Services WAA- Medical Specialty **Job… more
- System One (Baltimore, MD)
- ALTA IT Services is staffing a contract to hire opportunity for a Utilization Management Nurse to support a leading health insurance customer. The UM ... Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical policy, evidence based published research, national accreditation and… more
- ERP International (Camp Pendleton, CA)
- …CM software, and databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with social ... multidisciplinary team to meet the health care needs, including medical and/or psychosocial management , of specified patients....for community resources, etc. + Integrate CM and utilization management ( UM ) and integrate nursing case … more
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