- Baystate Health (Springfield, MA)
- …UM Regulatory Nurse Specialist** is responsible for delivering medical or behavioral health utilization management ( UM ) and coordination of care ... - Maximum $96,137.00 - $110,510.00 - $130,728.00 ** UM Regulatory Nurse Specialist - Baystate Health , Health New England** This is a **full-time remote… more
- CenterWell (Austin, TX)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Hackensack Meridian Health (Belle Mead, NJ)
- …The **Utilization Management Coordinator** utilizes clinical knowledge and understanding of behavioral health resource management to review and coordinate the ... caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse , and other members of the treatment team, ACCESS...+ Minimum five years of clinical experience in a behavioral health care setting. + Excellent written… more
- CVS Health (Phoenix, AZ)
- …be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate, evidence-based care. You'll ... **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team....Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient… more
- Veterans Affairs, Veterans Health Administration (Milwaukee, WI)
- …to acute and observation admissions and continue stay reviews for medical, surgical and behavioral health patient populations. The UM RN activities include ... Summary The Utilization Management ( UM ) Registered Nurse (RN) is responsible...up to 5% in contributions by VA Insurance: Federal health /vision/dental/term life/long-term care (many federal insurance programs can be… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …direct, face\-to\-face interaction\. **What You'll Do** + Apply your knowledge of ** Behavioral Health ** and **Withdrawal Management diagnoses** \. + Navigate the ... **continuum of care** and levels of care for Behavioral Health and Withdrawal Management\. + Present cases confidently and effectively during clinical rounds\. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, ... health care services. Examples may include: Utilization Management, Quality, Behavioral Health , Pharmacy, Registered Dietitian and Respiratory Therapist +… more
- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + ... is not accepting applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review… more
- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + ... each and every day. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote...accepting applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years'… more
- Highmark Health (Annapolis, MD)
- …panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of ... various resources to assist members in achieving their personal health goals. Will work with providers to insure quality...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
- Humana (Madison, WI)
- …participates with facility discharge planners, Care Coordinators/Care Managers and the behavioral health personnel in coordinating the member's discharge needs. ... team to keep things running smoothly. If you're a nurse who loves collaborating, problem-solving, and making a difference,...+ Monitors outpatient and behavioral health activities daily for outcomes related… more
- Saint Francis Health System (Tulsa, OK)
- …the level of care utilization. Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures and documentation to permit ... therefrom or Master's degree in Social Work, Counseling or related behavioral health field. Licensure, Registration and/or Certification: Valid multi-state… more
- Magellan Health Services (Albuquerque, NM)
- …Nursing, Bachelor's - Occupational Therapy, Bachelor's - Physical Therapy, Master's - Behavioral Health Education - Preferred License and Certifications - ... with claims payment policies and processes. Also oversees the health plans 24/7 Nurse Line program and...meetings as needed. + Audits and reviews case manager, Health guide, UM staff, vendor, and provider… more
- Elevance Health (Atlanta, GA)
- …granted as required by law. **How you will make an impact:** + Coordinates specific health coaching as directed by nurse case manager to address objectives and ... as required. **Preferred Skills, Capabilities and Experiences:** + Prior experience in health coaching, disease management and knowledge of behavioral and/or… more
- University of Southern California (Alhambra, CA)
- …10. Demonstrates collaborative working relationship with care team members, including pharmacy, behavioral health , field team, office staff, and facility staff. ... coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a… more
- Elevance Health (Winston Salem, NC)
- …terminology training and experience in medical or insurance field preferred. + Behavioral health medical terminology strongly preferred. + For URAC accredited ... requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data...identification and data entry of referral requests into the UM system in accordance with the plan certificate. +… more
- University of Michigan (Ann Arbor, MI)
- …relationships are essential to high-quality care. Our team prioritizes mutual respect, mental health and well-being both for the families we serve and for our ... uses a holistic approach that integrates physiological, developmental, psychosocial, and behavioral factors to prevent and address feeding disorders. It is staffed… more
- Tenet Healthcare (Detroit, MI)
- …: Minimum Qualifications BSN preferred. At least two (2) years acute hospital or Behavioral Health patient care experience required. One (1) year hospital acute ... healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make...or behavioral health case management experience preferred. Active… more
- San Antonio Behavioral Health (San Antonio, TX)
- …staff as needed. Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all ... indicated. + Identify and facilitate resolution of system process problems impeding UM functions. Identify and resolve delays and obstacles as appropriate. +… more
- Molina Healthcare (Akron, OH)
- …* Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
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