- TalentBurst, Inc (Irving, TX)
- TalentBurst, Inc is seeking a travel nurse RN Utilization Review for a travel nursing job in Irving, Texas.Job Description & RequirementsSpecialty: Utilization ... responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize… more
- University of Miami (Miami, FL)
- University of Miami is seeking a Registered Nurse (RN) Infusion Level II for a nursing job in Miami, Florida.Job Description & RequirementsSpecialty: ... daysEmployment Type: StaffMeets requirements of Clinical Trials Senior Chemotherapy Nurse 30%Administers research study agents, standard chemotherapy and biotherapy… more
- Community Health Plan of Washington (Eugene, OR)
- …criteria utilized for medical review. * Regularly communicates with the UM Manager, Medical Director, physician advisor/reviewer and primary care physician for ... support, problem resolution and notification of decertification and appeals. * Using established screening tools, identify candidates and recommend enrollment into care management and disease management programs. * Identify quality of care issues and report… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra seeks a Utilization Management ( UM ) Nurse Clinical Reviewer - LPN/RN (Remote US) to join our growing ... related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns. + Functions as… more
- CVS Health (Harrisburg, PA)
- …verbal and written Required Qualifications + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required + Must have active current and ... unrestricted RN licensure in state of residence + Must possess 1+ years of clinical experience in acute or post-acute setting + Must be available to work Monday through Friday from 8 AM to 5 PM in resident time zone; -Some weekends and holidays will be… more
- AdventHealth (Tampa, FL)
- …does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated ... **The role** **you'll** **contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical expertise by analyzing patient… more
- Bassett Healthcare (Cooperstown, NY)
- …admission order and validates status and level of care matches order. Collaborates with UM Nurse to assure that all payor and status requirements are aligned ... Nurse on discharge needs/barriers for all patients; initiates intervention by UM Nurse as needed. Identifies need for patient to receive IM letter;… more
- CVS Health (Columbus, OH)
- …9:30am-6:00 pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative ... to make health care more personal, convenient and affordable. This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can live in any… more
- CVS Health (Columbus, OH)
- …- 4:30pm Eastern Standard Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process ... health care more personal, convenient and affordable. Position Summary This Utilization Management ( UM ) Nurse Consultant role is fully remote and employee can… more
- CVS Health (Columbus, OH)
- …role is fully remote and employee can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to ... Experience Medicare/Medicaid populations - MCG experience - Managed care experience - UM Certification - MedCompass - 1+ year(s) of inpatient utilization experience… more
- CVS Health (Lansing, MI)
- …time.) No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in a ... our benefit programs, please visithttps://jobs.cvshealth.com/employee-benefits (https://protect-usb.mimecast.com/s/HChtCEKL7mupo2P4Q84HN2Ovk?domain=jobs.cvshealth.com) Required Qualifications Registered Nurse in state of residence 3+ years of Nursing… more
- AdventHealth (Orlando, FL)
- …does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated ... **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical expertise by analyzing patient records… more
- Omaha Children's Hospital (Omaha, NE)
- …regulatory requirements, payer issues, and benefits management. + Understands the NCM and UM Nurse role in revenue cycle management. + Collaborates with the ... policies. + Communicates and collaborates with the Utilization Management ( UM ) Nurse , or other NCMs as necessary... UM Nurse to identify and document Avoidable... UM Nurse to identify and document Avoidable Days according to… more
- Omaha Children's Hospital (Omaha, NE)
- …regulatory requirements, payer issues, and benefits management. * Understands the NCM and UM Nurse role in revenue cycle management. * Collaborates with the ... processes. + Communicates and collaborates with the Utilization Management ( UM ) Nurse , or other NCMs as necessary... UM Nurse to identify and document Avoidable... UM Nurse to identify and document Avoidable Days according to… more
- Stanford Health Care (Palo Alto, CA)
- …an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be responsible for ensuring the efficient and ... Care (SHC)? Here is your opportunity to work with the unique and supportive UM team. You can put your knowledge about Medicare, Medi-Cal, Medicaid, and bedside RN… more
- Truman Medical Centers (Kansas City, MO)
- …coaching and consulting to outside organizations. **Job Description** The Utilization Management Nurse ( UM RN) collaborates with members of the healthcare team ... optimum delivery of services across the healthcare continuum. The UM RN partners with interdisciplinary teams to improve delivery...in a combination of education and experience + Registered Nurse licensed in state of Missouri, BSN preferred +… more
- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM ... carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials, notifying… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) ... Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager ( UM ) partners with the Centralized Patient Placement Center (CPPC) RN's to… more
- Evolent Health (Columbus, OH)
- …**What You Will Be Doing:** + Leadership of utilization management ( UM ) activities including design, implementation, and oversight of the operations. Operational ... features such as training, appeals, and grievances for clients who have delegated UM . + Monitor all activities related to clinical review. Develop processes where… more
- Molina Healthcare (New York, NY)
- …Clinician with Prior Authorization experience. Candidates with Utilization Management ( UM ) and MLTC/LTC experience are highly preferred. Additional experience with ... Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
