- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- CVS Health (Phoenix, AZ)
- …for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the ... times may vary based on business needs. Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, ... cost‑effective patient care from a fully remote environment. This role is ideal for nurses who...ensure appropriate levels of care. Key Responsibilities + Conduct utilization reviews for inpatient, outpatient, and ancillary services using… more
- CVS Health (Austin, TX)
- …+ Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live ... care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care +… more
- CVS Health (Austin, TX)
- …with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any ... care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care +… more
- Dartmouth Health (Lebanon, NH)
- …communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote ... * Area of Interest:Nursing * Pay Range:$79,747.20/Yr. - $127,587.20/Yr. (Based on 40 hours per week, otherwise pro rata) * FTE/Hours per pay period:.01 hrs/per week (per diem/temp) * Shift:Rotating * Job ID:35880 Dartmouth Health offers a total compensation… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- CVS Health (Columbus, OH)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position Summary** The Team Lead plays ... 8:00am-5:00pm EST (Shift times vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division… more
- Centene Corporation (Harrisburg, PA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... including a fresh perspective on workplace flexibility. **THIS POSITION IS REMOTE /WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS MEDICAID CHIP PROGRAM.**… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... including a fresh perspective on workplace flexibility. POSITION IS REMOTE WITH POTENTIAL TO WORK WEEKENDS AND HOLIDAYS IDEAL...CAROLINA OR FLORIDA ** **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Centene Corporation (Madison, WI)
- …weekend / holiday coverage. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to… more
- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... 3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department...ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency in MS… more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- CVS Health (Frankfort, KY)
- …it all with heart, each and every day. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant. **Must reside in the state of ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Penn Medicine (Lancaster, PA)
- …our future each day. Are you living your life's work? **LOCATION:** Fully remote position after 12-week onsite orientation **HOURS:** Full Time (40 hours per week). ... Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for patients by… more
- Molina Healthcare (WI)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- CVS Health (Topeka, KS)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- CareFirst (Baltimore, MD)
- …Grievances in a healthcare payor organization. 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of...and mandates. + Organizes the appeal case for physician review by compiling clinical, contractual, medical policy and claims… more