- Almost Family (Oshkosh, WI)
- …MO, NC, NY, OH, PA, TN, VA: No additional requirements. Skill Requirements Prior management experience preferred. Knowledge of home care regulations and ... for home care services and establishment of frequencies and utilization for new admissions. Works closely with the Agency...staff as directed. License Requirements Must be a Registered Nurse licensed in the state of practice. Minimum of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... any time with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced based… more
- CVS Health (Lansing, MI)
- …8a-5pm Est time.) No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in ... internal and external constituents in the coordination and administration of the utilization /benefit management function. For more information on our benefit… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …VA Healthcare System, Louisville, Kentucky is currently recruiting for a Registered Nurse - Utilization Management in Quality and Patient Safety Louisville, ... Kentucky 603. Responsibilities The Nurse Ill Utilization Management (UM)...Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- CVS Health (Austin, TX)
- …make health care more personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical ... Qualifications + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...business needs + 12.5% shift differential Preferred Qualifications + Prior authorization or Utilization Management … more
- Martin's Point Health Care (Portland, ME)
- …requests for services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...nursing experience as a RN, with a focus of Utilization Management in a managed care environment.… more
- Martin's Point Health Care (Portland, ME)
- … required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment required ... certified as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a team responsible for… more
- Katmai (Usaf Academy, CO)
- …Bachelor of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...None. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- CVS Health (Raleigh, NC)
- …Following training, position is remote with occasional in office requirement. Utilization Review - Precertification Nurse is responsible for telephonically ... assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- CVS Health (Phoenix, AZ)
- …talking, listening and computer useRequired Qualifications + 1+ year varied Utilization Management experience within an inpatient/Outpatient setting, concurrent ... review or prior authorization. + 5+ years of variety clinical experience...with 100% participation during 8:30am-5pm Monday-Friday. + A Registered Nurse that must hold an unrestricted license in their… more
- CVS Health (Phoenix, AZ)
- …and services both inpatient and outpatient services requiring precertification. + Utilization Management nurses use specific criteria to authorize ... 1+ year: Oncology and Transplant UM, concurrent review or prior authorization + 3+ years: acute clinical Oncology or...100% participation during 8:30am-5pm Monday-Friday EST. + A Registered Nurse that must hold an unrestricted license in their… more
- US Tech Solutions (May, OK)
- …experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- CVS Health (Louisville, KY)
- …licensure in state of residence + 3+ years of clinical experience + 2 years of Utilization Management experience + Must be wiling and able to work Monday through ... to work in a fast paced environment Preferred Qualifications + Previous prior authorization or acute experience Education Associates degree required BSN preferred… more
- Providence (Beaverton, OR)
- …best people, we must empower them._** **Providence Health Plan is calling a Manager Utilization Management RN, Prior Authorization who will:** + Be ... for Management and supervision of the PHP Utilization Management (UM) or Care Management...experience + Coursework/Training: Formal education or training in supervision, management , or leadership + Oregon Registered Nurse … more
- Centene Corporation (Salem, OR)
- …key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization, ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. **(Location must reside in Oregon)** + Monitors… more
- Centene Corporation (NJ)
- …issues related to member care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent ... with applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- YesCare Corp (Bartow, FL)
- …Veterans._ **Responsibilities** Below is a list of your responsibilities as a ** Utilization Management Coordinator** with YesCare: + Confirms admissions with ... outside hospitals and notifies the Utilization Management Department of need to report...to arrange discharge plan + Coordinates with the hospital utilization nurse to expedite discharge and avoid… more
- Hackensack Meridian Health (Brick, NJ)
- …skills + Familiar with hospital resources, community resources, and utilization management + NJ State Professional Registered Nurse License required + AHA ... serve as a leader of positive change. The **Care Management , Care Coordinator** , ** Utilization Management...regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices) + Maintains… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices). + Maintains… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The **Case Management Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices) + Maintains… more
