- CVS Health (Columbus, OH)
- …1 holiday per year).** There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is fully remote… more
- CVS Health (Harrisburg, PA)
- …of Saturday shift is approximately 1 per month.** No travel is required. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote… 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 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, 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,… more
- Elevance Health (Washington, DC)
- The Utilization Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member ... and minimum of 2 years acute care clinical experience. + Minimum 1 year Utilization Management experience preferred. For candidates working in person or remotely… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and ... department productivity to meet targets. + Participates in all aspects of utilization management . Assist with strategies, plans and workflow development in… more
- CVS Health (Carson City, NV)
- …all noncompact states. + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent review or prior ... Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management… more
- CVS Health (Raleigh, NC)
- …more personal, convenient and affordable. **Position Summary** **This is a fully remote Utilization Management opportunity.** Utilization management is a ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...in EST or CST + Managed Care experience + Utilization review experience **Education** + Minimum of… more
- CVS Health (Columbus, OH)
- …personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days **including ... and UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience in ER, triage, ICU,… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Matrix Providers (Aurora, CO)
- Registered Nurse (RN) - Utilization Management Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... fair, reliable schedules. Matrix Providers is hiring a Registered Nurse (RN) - Utilization Management ...care clinical setting and 12 months consecutive experience in utilization management , utilization review… more
- HCA Healthcare (Campbell, CA)
- …opportunity. We want your knowledge and expertise! **Job Summary and Qualifications** The ** Utilization Management Nurse ** 's primary function is to ensure ... we encourage you to apply for our Utilization Management RN opening. We promptly review all applications. Highly qualified candidates will be contacted for… more
- University of Rochester (Rochester, NY)
- Responsibilities **General Description:** The Utilization Management Nurse role is a unique and exciting opportunity that blends the knowledge of nursing and ... is remote with some on-site requirements as needed. **Qualifications** **:** RN with Utilization Review experience preferred; 3-5 years of recent acute hospital… more
- Stanford Health Care (Palo Alto, CA)
- …assistance! **This is a remote Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ... management principles. + Experience in case management , utilization review , or related...healthcare software. **Licenses and Certifications** + Nursing/RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- McLaren Health Care (Mount Clemens, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... equivalent through the Military Training network (MTN) _Preferred:_ + Experience in utilization management /case management , critical care, or patient… more
- AdventHealth (Orlando, FL)
- …water, creating a holistic environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical ... reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. +… more
- Bon Secours Mercy Health (Suffolk, VA)
- …care transitions. + Verifies patient's needs for acute level of care, collaborating with utilization management nurse to prevent potential denials. The care ... rules and regulations and Conditions of Participation for DC Planning and Utilization Review , and address opportunities or potential concerns with leadership.… more
- University of Virginia (Charlottesville, VA)
- Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management process. They collaborate with ... UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly...and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning… more
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