- Actalent (Omaha, NE)
- …in medical review or utilization management. + Knowledge of utilization review , Medicare, utilization management, and EMR systems. Additional Skills ... Utilization Management NurseJob Description We are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate… more
- Veterans Affairs, Veterans Health Administration (Fort Meade, SD)
- …from the community. He/she possesses the knowledge related to VHA guidelines, utilization review criteria, current evidence-based standards of care, compliance ... Summary Utilization Management (UM) Registered Nurse functions...attending physician and PUMA. Educates providers about compliance with utilization review principles and documentation requirements. Educates… more
- Veterans Affairs, Veterans Health Administration (Tucson, AZ)
- Summary Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative approaches to ... implements, and evaluates care based on age specific components. Responsibilities Utilization Management (UM) Registered Nurse (RN) executes position… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …the healthcare continuum. Performs other duties as assigned. The ED-UM RN performs utilization review activities, ensuring appropriate level of care and status ... Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN)...on all patients reviewed in the ED. Conducts initial review using InterQual, and other tools, and assists provider… more
- CVS Health (Trenton, NJ)
- …more 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 will utilize...and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with… more
- CVS Health (Harrisburg, PA)
- …health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in ... any state. As a Utilization Management Nurse Consultant, you will utilize...on business needs **Preferred Qualifications:** - 1+ years' experience Utilization Review experience - 1+ years' experience… 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 ... criteria and best clinical documentation to ensure efficient resource utilization . Accreditation deals with external quality assurance processes, inspections and… more
- Humana (Boise, ID)
- …interpretation and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...as needed by the business + This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- CVS Health (Carson City, NV)
- …UM ( utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization. + 1+ years Managed Care (MCO) preferred. ... make health care more personal, convenient and affordable. **Position Summary** **100% remote position from anywhere in the US** **Work hours: 11:30am-8:00pm EST,… more
- CVS Health (Raleigh, NC)
- …more personal, convenient and affordable. **Position Summary** **This is a fully remote Utilization Management opportunity.** Utilization management is a ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...in EST or CST + Managed Care experience + Utilization review experience **Education** + Minimum of… more
- Elevance Health (Tampa, FL)
- …managed care industry strongly preferred. + 2 years of experience in In-Patient, utilization review / management, evaluating medical necessity for services and ... RN Utilization Management Nurse Sr. (Medicaid-InPatient) JR130851...Tampa or Miami, FL offices. This is primarily a remote position but may be required to go in… more
- CVS Health (Charleston, WV)
- …care more personal, convenient and affordable. **Position Summary** This is a fully remote Utilization Management Nurse Consultant opportunity. The schedule ... EST time zone where the candidate resides. **.** Responsible for the review and evaluation of clinical information and documentation related to outpatient therapy… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Nurse (RN)** **$3,000 SIGN ON BONUS OFFERED** **Location** : Remote opportunity. Must reside in the state of Kentucky. The ** ... Utilization Management Nurse (RN)** is responsible to...are not limited to: + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- VNS Health (Manhattan, NY)
- …general supervision. Compensation Range:$98,200.00 - $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing ... Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with...and current registration to practice as a registered professional nurse in New York State Required Valid driver's license… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… more
- Centene Corporation (Baton Rouge, LA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... Therapist (LMFT + Licensed Mental Health Professional (LMHP) + RN - Registered Nurse - State Licensure and/or Compact State Licensure required with Behavioral Health… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... basic computer skills is essential for excelling in this remote position. **Here's what you will experience working as...position. **Here's what you will experience working as a Utilization Review Author:** + Perform initial admission… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... including a fresh perspective on workplace flexibility. POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF FLORIDA...Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more