- Novo Nordisk Inc. (Atlanta, GA)
- …relationships include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, advocacy group leaders, pharmacists, blood bank staff, ... policies, legal, regulatory, and compliance requirements Ensures effective administrative management of regional business as well as operational budgets Maintains… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality ... care for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines +… 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
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... in the area of service decisions and organizational determinations.The Manager, Utilization Management reports to the Director of Clinical Effectiveness.… more
- Humana (Boise, ID)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …with clinic, payor and other customers. **Job Title: Licensed Vocational Nurse Utilization Review -** ** Utilization Management -Sign on Bonus $2,500** ... **Responsibilities** The Utilization Review LVN nurse ...**Location: Remote** **Department:** ** Utilization Management ** **Job Type: Full Time** **Salary Range: $54,186 -… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care… more
- Actalent (Omaha, NE)
- … Management NurseJob Description We are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate ... experience in a healthcare setting. + Two years of experience in medical review or utilization management . + Knowledge of utilization review ,… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- Ascension Health (Manhattan, KS)
- …additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . + ... **Details** + **Department:** Utilization Management + **Schedule:** Full Time,...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - Utilization Review Nurse - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of ... regulatory compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management /clinical/or combination; 2 of ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within ... the healthcare continuum. Performs other duties as assigned. The ED-UM RN performs utilization review activities, ensuring appropriate level of care and status… more
- CVS Health (Trenton, NJ)
- …personal, convenient and affordable. **Position Summary** This is a full-time remote Utilization Management Nurse Consultant opportunity. Utilization ... include weekends and holidays and evening rotations. As a Utilization Management Nurse Consultant, you...and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with… more
- Veterans Affairs, Veterans Health Administration (Johnson City, TN)
- Summary Position shared between Utilization Management (UM) and Accreditation. UM uses evidence-based practices to create guidance on admission, continued stay ... QM programs such as patient safety, continuous readiness, performance measures, and risk management . - Participates in External Peer Review ; pulls and ensures… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse ...knowledge and is proficient with standard Utilization Review processes. The Utilization Management ... their appropriate admission status. This individual will support the Utilization Management process by maintaining effective and...+ Required: + Currently licensed as a Registered Professional Nurse in New York State. + Associates Degree +… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... of services and care. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- TEKsystems (Austin, TX)
- Job Summary + The Medical Records Utilization Case Manager will support documentation of medical necessity by facilitating medical records (MR) collection and client ... outreach, by offering expert review and interpretation on a case by case basis,...productive relationships within the organization relating to Revenue Cycle Management . Job Responsibilities: + Successfully obtain necessary medical documentation… 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
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