- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …compassionate whole health care to Veterans? Responsibilities The Utilization Management (UM) Registered Nurse (RN) executes position responsibilities ... knowledge of clinical appropriateness, functions, processes, and principles of utilization management . They must have strong interpersonal...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure...projects as needed. _Required:_ + State licensure as a registered nurse (RN) + Bachelor's degree in… more
- McLaren Health Care (Port Huron, MI)
- …as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care,...and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse (RN) ⦁ Bachelor's degree in… more
- University of Virginia (Charlottesville, VA)
- Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management ... UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the state of… more
- Dignity Health (Northridge, CA)
- …required. + Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or insurance setting required. + Previous ... 400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... interpretation and independent determination of the appropriate courses of action. The Utilization Management Registered Nurse 2 uses clinical knowledge,… more
- Dartmouth Health (Lebanon, NH)
- Overview The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health system ... leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered Nurse with NH eligibility - BLS certification… more
- Stanford Health Care (Palo Alto, CA)
- …adoption assistance! **This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- Cleveland Clinic (Weston, FL)
- Utilization Management Specialist Join Cleveland Clinic Weston Hospital's team of caregivers that remain on the leading edge of technology and education all ... of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities,...of professional nursing. + Current state licensure as a Registered Nurse (RN). + Basic Life Support… more
- Sutter Health (Burlingame, CA)
- **Organization:** Bay Administration **Position Overview:** Responsible for Utilization Management and accurate bed placement for patients coming in from the ED. ... **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN- Registered Nurse of California Upon Hire CCM certification preferred… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** Full Time, 40 hours weekly, Monday - Friday 7:30am - 4pm + **Hospital:** Ascension Via ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… 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...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse (RN) - Active, current and… more
- CVS Health (Austin, TX)
- …to make health care more personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant Utilization ... Required Qualifications + 3+ years of experience as a Registered Nurse + Must have active current...experience with Microsoft Office applications (Outlook, Teams, Excel) + Utilization Management is a 24/7 operation and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... and to support the safety net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in KY, IN, MI,… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Santa Fe, NM)
- …a part of our caring community and help us put health first** The Telephonic Utilization Management Nurse utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... discharge between levels of care and facilities Essential Qualifications + Current licensed Registered Nurse (RN) in good standing. Must retain active licensure… more