- CVS Health (Phoenix, AZ)
- …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....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- Actalent (Fort Worth, TX)
- …to assist each other and complete cases. Qualifications: + 3+ years of utilization management , concurrent review, prior authorization, utilization review, ... Immediate Hiring for " Remote Clinical Review Nurses" Job Description: + Review...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… 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 in ... **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to… more
- CVS Health (Austin, TX)
- …heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any ... **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to… 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 a ... 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
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Centene Corporation (Austin, TX)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH...and Family Therapist required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (New York, NY)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...pm with holiday rotation.** **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Madison, WI)
- …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 performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- Intermountain Health (Las Vegas, NV)
- …including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and ... + Occasional weekend or holiday coverage + Possibility of remote work some days + Main Location - Nevada...Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. **Preferred… more
- CVS Health (Frankfort, KY)
- …all with heart, each and every day. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant. **Must reside in the state of ... and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to coordinate,… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... day. Are you living your life's work? **LOCATION:** Fully remote position after 12-week onsite orientation **HOURS:** Full Time...we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible… more
- Centene Corporation (Springfield, IL)
- …experience in various mental health settings especially inpatient behavioral health units, utilization management / review, and youth or pediatric services.** ... on workplace flexibility. NOTE: NOTE: This is a fully remote completing reviews for Youth-In-Care or Former Youth-In-Care members,...Additional Details: * Department: Illinois Utilization Management * Business Unit: Illinois Health… more
- Centene Corporation (Austin, TX)
- …substance abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral ... experience is preferred + Experience in Behavioral Health Case Management or Utilization Management in...and Family Therapist required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (Topeka, KS)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Actalent (St. Louis, MO)
- …workspace. + Comfortable navigating electronic medical records and utilization management systems. What We Offer + Fully remote work environment. ... Remote Clinical Review Nurse - Prior...organizational standards. + Maintain up‑to‑date knowledge of clinical guidelines, utilization management policies, and industry best practices.… more
- Actalent (Baton Rouge, LA)
- …service. + Knowledge of Medicare and Medicaid regulations. + Familiarity with utilization management processes. Additional Skills & Qualifications + Experience ... Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the… more
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