- CVS Health (Austin, TX)
- …convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate,… more
- CVS Health (Phoenix, AZ)
- …convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in ... per the need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate,… more
- CVS Health (Tallahassee, FL)
- …schedules may include weekends and holidays and evening rotations. This is a full-time remote Utilization Management Nurse Consultant opportunity. As a ... health care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work... Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate,… more
- CVS Health (Tallahassee, FL)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...clinical experience in acute or post acute setting + Utilization management is a 24/7 operation. Work… more
- Humana (Frankfort, 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
- Humana (Boise, ID)
- **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...as needed by the business + This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- CVS Health (Jefferson City, MO)
- …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
- CVS Health (Columbus, OH)
- …more personal, convenient and affordable. **Position Summary** **This is a fulltime remote Utilization Management opportunity.** **The schedule is Monday ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + UMNC meets set productivity and… 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 ... Nurse will perform prospective, concurrent and retrospective reviews for...coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates,… 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 ... quality issues or complaints, and/or approvals requiring next level authorization (eg, utilization management , high cost services, out of network services,… more
- VNS Health (Manhattan, NY)
- …in development of plans to address improvement needs as appropriate. * For Utilization Management Only: * Issues Determinations, Notices of Action, and other ... by state or federal regulations are saved in the Utilization Management System. * Reviews, evaluates and...Certifications: Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York State… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates,… more
- VNS Health (Manhattan, NY)
- …Annual * Supervises the day-to-day operations of VNS Health Plans Medical Management clinical and non clinical staff. Makes recommendations to the development, ... utilization , and evaluation of internal processes to ensure customer...in addressing and resolving day-to-day operational issues. * Assists management team in the development of long- and short-… more
- Stanford Health Care (Palo Alto, CA)
- …**This is a remote Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- Centene Corporation (Madison, WI)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Penn State Health (Hershey, PA)
- …the future. Remote opportunity for individual highly skilled in utilization management **MINIMUM QUALIFICATION(S):** + Bachelor's Degree in Nursing required ... Manager Utilization Management - DAY SHIFT - Utilization Management **Location** US:PA: Hershey | Registered Nurse | Full Time **Req ID** null more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...New Jersey regulations for Nursing **.** **This is a remote , night shift position. The schedule for this role… 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
- Adecco US, Inc. (Minneapolis, MN)
- …to $34.86/hr **Location:** Remote / work from home **Responsibilities of the Utilization Management LPN:** * In collaboration with the Manager of Delegation ... Adecco Healthcare & Life Sciences is hiring for a ** Utilization Management ** **LPN** to work **remotely** !... LPN:** * Graduation from an accredited Licensed Vocational/Practical Nurse program * Current LVN/LPN license in State of… more
- CVS Health (Charleston, WV)
- …make health care more personal, convenient and affordable. This is a fully ** remote ** Utilization Review Clinical Consultant with a schedule of Monday-Friday, ... and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to coordinate,… more
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