- 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 (Medford, 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 (Carson City, NV)
- …required 3 weeks training required 100% participation during 8:30am-5pm EST Monday-Friday As a UM Nurse Consultant you will work in a clinical telephone queue ... working with providers to secure additional information for prior authorization reviews. -This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. -Utilizes clinical… more
- Insight Global (Long Beach, CA)
- …inpatient reviews to determine financial responsibility for the company and its members. Each nurse will care for 25-30 cases. Across the LA county, they are caring ... inpatient acute care/medical experience; ICU, Medsurge, etc - Current California Registered Nurse license OR LVN - Strong critical thinking and communication skills;… more
- CVS Health (Albany, NY)
- …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+ year(s) of clinical experience in acute or post-acute setting + Must be available to work Monday through Friday from 8 AM to 5 PM EST. Some weekends and holidays will be required Preferred… 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 (Richmond, VA)
- …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
- Humana (Indianapolis, IN)
- …require interpretation and independent determination of the appropriate courses of action. The UM Nurse responsibilities include (but not limited to): + Uses ... Humana Healthy Horizons in Indiana is seeking Utilization Management ( UM ) Nurses who utilize clinical nursing skills to support...to make an impact** **Required Qualifications** + Licensed Practical Nurse (LPN) in the State of Indiana with no… 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
- 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
