- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality ... care for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines +… more
- Humana (Columbus, OH)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- Glens Falls Hospital (Glens Falls, NY)
- …be foundhere. **Job:** **Nursing - Case Management * **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** *2410V* ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 250102-5612FP-001 Location Hartford, CT Date Opened 1/6/2025 12:00:00 AM Salary $78,480 - ... and Addiction Services ( DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) as a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) !… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management /clinical/or combination; 2 of ... from your internet provider (non-satellite). + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical… more
- Matrix Providers (Aurora, CO)
- Registered Nurse (RN) - Utilization Management Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... fair, reliable schedules. Matrix Providers is hiring a Registered Nurse (RN) - Utilization Management ...care clinical setting and 12 months consecutive experience in utilization management , utilization review… more
- Ascension Health (Wamego, KS)
- …time of the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . + ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- University of Washington (Seattle, WA)
- …) **UW Medical Center** has an outstanding opportunity for an **experienced Utilization Review Nurse (UM RN)** to join our ... Req #: 236354 Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT Job Location Detail: Position...training + Active licensure to practice as a Registered Nurse in Washington State required by start date +… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management /clinical/or combination; 2 of ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage ... with occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse (RN)...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… 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 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses;...in a direct patient care clinical setting. Must have utilization management , utilization review… more
- Cleveland Clinic (Weston, FL)
- …stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, ... Utilization Management Specialist Join Cleveland Clinic... (UM) Specialists perform UM activities, such as admission review , concurrent review , retrospective chart review… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... advancement opportunities What You Will Do + Conducts comprehensive review of all components related to requests for services...by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... + Clinical experience in post-acute setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record… more
- Texas Health Resources (Arlington, TX)
- **RN/Registered Nurse - Utilization Management , Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort Worth ... criteria preferred **Licenses and Certifications** + RN - Registered Nurse Current license to practice professional nursing in the...each initial review via CareConnect1 or other Utilization Management tool. Discusses working DRG issues… more