- Actalent (Santa Barbara, CA)
- …Title: Health Plan Nurse Coordinator Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a ... 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote...with a leading healthcare organization Description: The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse … more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and...+ Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State… more
- CVS Health (Trenton, NJ)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) -...8am - 4:30pm Weekend Rotation Required This is a remote position where the ideal candidate would be located in ... effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening… more
- Humana (Lexington, KY)
- …and help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- CVS Health (Tallahassee, FL)
- …members sign up to work one major and one minor holiday yearly. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... health care more personal, convenient and affordable. **Position Summary:** Utilization Management is a 24/7 operation and...include weekends, holidays, and evening hours. This role is remote anywhere in the US. Schedule for this role… more
- Texas Health Resources (Arlington, TX)
- **RN/Registered Nurse - Utilization Management , Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort ... from 6:45am -3:15pm **Department highlights:** + Flexible schedule + Remote work environment + Collaborative team approach **Here's What...an acute hospital setting required and + 1 Year Utilization Management required and + Experience in… more
- CVS Health (Harrisburg, PA)
- …Friday 8:00 am to 5:00 pm CST with rotating late evening and weekend shifts. Utilization Management is a 24/7 operation and work schedule may include weekends, ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + Must reside in… more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This ... or complaints, and/or approvals requiring next level authorization (eg, utilization management , high cost services, out of...and current registration to practice as a registered professional nurse in New York State Required + Valid driver's… more
- US Tech Solutions (Columbia, SC)
- **Job Description:** + Remote once training is complete. M-F 8:30am - 5pm. No 10hr schedules available at this time. + From the Manager: -Experience: Hospital ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and… more
- University of Washington (Seattle, WA)
- Req #: 236354 Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT Job Location Detail: Position supports both UW Medical Center campuses Posting Date: ... Medical Center** has an outstanding opportunity for an **experienced Utilization Review Nurse (UM RN)** to join...POSITION QUALIFICATIONS** + 3 years of work experience in utilization management + 5 years of nursing… more
- Community Health Systems (Franklin, TN)
- …The manager supports and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities. Works with UR ... clinical expertise to ensure quality, timely, and cost effective utilization management to achieve optimal outcomes. The...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
- Community Health Systems (Franklin, TN)
- …clinics, imaging centers, cancer centers and ambulatory surgery centers. **Summary:** Utilization management is the analysis of the necessity, appropriateness, ... Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse or Licensed Registered NursePreferred License/Registration/Certification: ACM or CCM… more
- Centene Corporation (Tallahassee, FL)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Raleigh, NC)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... to obtain and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families, providers, medical… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...with no disciplinary action. + This is a fully remote permit 10-hour shift weekend position (Thurs-Sun) - must… more
- Kelsey-Seybold Clinic (Houston, TX)
- …business needs **Job Title: Utilization Review Specialist (LVN)** **Location: Remote ** **Department:** ** Utilization Management ** **Job Type: Full Time** ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to determine… more
- University of Rochester (Strong, AR)
- …of the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE: The Utilization Management Nurse role is a unique and ... Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: UR - Day...needs of the department. The majority of work is remote with some on-site requirements as needed. **ESSENTIAL FUNCTIONS**… more
- Humana (Columbus, OH)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
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