- CVS Health (Phoenix, AZ)
- …solutions to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is ... of the department. No travel is required. As a Utilization Management Nurse Consultant, you...turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not… more
- Stanford Health Care (Palo Alto, CA)
- …is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be responsible for ensuring the ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- Omaha Children's Hospital (Omaha, NE)
- …meets department guidelines, standards, and policies. + Communicates and collaborates with the Utilization Management ( UM ) Nurse , or other NCMs ... achieved in a timely manner while facilitating appropriate resource utilization and enhancing customer satisfaction. **Essential Functions** + Performs...benefits management . + Understands the NCM and UM Nurse role in revenue cycle … more
- Hackensack Meridian Health (Belle Mead, NJ)
- …transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral ... caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse , and other members of the treatment team, ACCESS...level of care setting for continued treatment. Employs the utilization management process to assist in setting… more
- Integra Partners (Troy, MI)
- …& Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ideal candidate will have a ... industry standards, regulatory requirements, and best practices in clinical documentation and utilization management and update training documents as required +… more
- LifePoint Health (Las Cruces, NM)
- …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... observation and concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed to ensure… 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 ... concurrent reviews. The Senior UM Coordinator reports to the Manager, Utilization Management and/or Supervisor, UM Coordinators. Primary Responsibilities… more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. This is a full-time remote position. Utilization management is a 24/7 operation. Work schedules will include ... 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
- Centers Plan for Healthy Living (Jamaica, NY)
- UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435, USA...plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a ... or support in their home to improve their quality of life. The Utilization Management nurse will assess and process all authorization requests to determine… more
- Magellan Health Services (Boise, ID)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience… more
- Centers Plan for Healthy Living (Margate, FL)
- …Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer ... UM Clinical Reviewer 5297 W Copans Rd, Margate,...in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and… more
- Medical Mutual of Ohio (OH)
- …**Under general supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives and reviews ... external guidelines.** **Prepares and assigns cases/files to clinical staff ( Nurse , Social Worker, Care Navigator, Physician)** **.** **Responsibilities** + **Sends… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and… 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 ... RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission… more
- Veterans Affairs, Veterans Health Administration (Chillicothe, OH)
- Summary The Risk Manager Quality Nurse (RM/ UM ) is responsible for the Medical Center Risk Management Program which identifies risk that may adversely affect ... opportunities to prevent or control risks, mitigate harm and management of issues. The RM/ UM contributes to...policy. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases,… more
- CVS Health (Carson City, NV)
- …of the cost of residential broadband service. + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their… more
- Cleveland Clinic (Vero Beach, FL)
- …rewarding career with one of the most respected healthcare organizations in the world. Utilization Management ( UM ) Specialists perform UM activities, ... initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at... Certification (CCM) preferred. + Two years of care management or UM experience. Our caregivers continue… 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
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day ... Supervisor, Utilization Management RN Job Category: Clinical Department:...operations of the UM department, and monitoring the Care Management (CM)… more
- CVS Health (Springfield, IL)
- …and external constituents in the coordination and administration of the utilization /benefit management function **Required Qualifications** -3+ years of ... preference for those residing in EST or CST. _Utilization Management is a 24/7 operation and work schedule may...experience as a Registered Nurse -Must hold active and unrestricted RN licensure in… more