- CVS Health (Columbus, OH)
- …of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role in ... phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment to… more
- Actalent (Minnetonka, MN)
- Remote Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and ... to assess the medical necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review . + Experience in acute… more
- Centene Corporation (New York, NY)
- …clinical license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- BJC HealthCare (St. Louis, MO)
- …of RN experience performing care for hospitalized patients + 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity + ... team! This is a great opportunity for a local remote position. There is no communication with patients. This...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… more
- Integra Partners (Troy, MI)
- …in a payer or managed care environment. + Strong understanding of utilization review , authorizations, and appeals processes. + Excellent verbal/written ... The Utilization Management (UM) Nurse Supervisor is...necessity criteria (eg, InterQual, CMS, health plan policies). + Review and process clinical and administrative appeals; coordinate with… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- CVS Health (Lansing, MI)
- …solutions that promote high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply ... some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% ...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- Dartmouth Health (Lebanon, NH)
- …communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote ... * Area of Interest:Nursing * Pay Range:$79,747.20/Yr. - $127,587.20/Yr. (Based on 40 hours per week, otherwise pro rata) * FTE/Hours per pay period:.01 hrs/per week (per diem/temp) * Shift:Rotating * Job ID:35880 Dartmouth Health offers a total compensation… more
- CenterWell (San Juan, PR)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Trinity Health (Columbus, OH)
- …of the Director, Utilization Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities. ... / Certification: Current license to practice as a Registered Nurse in their home state or hold a compact...nursing experience with at least 2 years' experience in utilization review or case management. Nursing experience… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote . This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and ... Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Centene Corporation (Harrisburg, PA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... including a fresh perspective on workplace flexibility. **THIS POSITION IS REMOTE /WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS MEDICAID CHIP PROGRAM.**… more
- Centene Corporation (Austin, TX)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- State of Michigan (Lansing, MI)
- …program. To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors ... Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight...Biweekly Location Lansing, MI Job Type Permanent Full Time Remote Employment Flexible/Hybrid Job Number 3901-26-HSA-MCMCS-001-EST Department Health and… more
- AmeriHealth Caritas (LA)
- …Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...uses clinical judgment in their application **Work Arrangement** + Remote position + Monday through Friday 8:00 AM to… more
- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
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