- US Tech Solutions (RI)
- …support as required. **Responsibilities:** + Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit ... Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION... review. + MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more
- CVS Health (Austin, TX)
- …department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant , you will utilize clinical skills ... Social Worker (LCSW) preferred. + Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and… more
- CVS Health (Carson City, NV)
- …per year). There is no travel expected with this position. As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, ... we do it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside… more
- CVS Health (Columbus, OH)
- …operation and work schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant ** Fully Remote- WFH **Schedule** - Mon-Fri 10:30AM-7PM with ... alternate weekends and holidays **Position Summary:** UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to assess, plan,… more
- CVS Health (Madison, WI)
- …it all with heart, each and every day. **Position Summary:** The **Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes clinical ... skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. **Job Duties include (but are not limited to):** + Applies… more
- CVS Health (Lansing, MI)
- …that promote high- quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant , where you'll apply ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- CVS Health (Raleigh, NC)
- …with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization Management ... other products, services and/or programs + Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and… more
- CVS Health (Tallahassee, FL)
- …in the state of Florida. **Applicant must reside in Florida** . As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, ... we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and… more
- CVS Health (Baton Rouge, LA)
- …it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts high-acuity, ... in UM systems, ensuring data integrity and compliance. * Participate in quality improvement, policy review, and education related to utilization management .… more
- CVS Health (Baton Rouge, LA)
- …do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts ... in UM systems, ensuring data integrity and compliance. * Participate in quality improvement, policy review, and education related to NICU and special populations… more
- HCA Healthcare (Brooksville, FL)
- …you passionate about delivering patient-centered care?** Submit your application for RN Registered Nurse Lactation Consultant position and spend more time at the ... clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at HCA...**Job Summary and Qualifications** We are seeking a Lactation Consultant Registered Nurse for our Obstetrics Unit.… more
- PruittHealth (Columbia, SC)
- **Description - External** **JOB PURPOSE:** Senior Nurse Consultant assumes responsibility for conducting quality assurance reviews in the assigned ... facilities. Senior Nurse Consultant recommends resources in an efficient and economical manner...* Desired Software: Matrix Care, Point Right, AHT, Abaqis ( Quality Management System), COMS * Expert level… more
- NHS Management, LLC (Fayetteville, AR)
- …the successes they experience along the way. We are in search of a qualified Regional Nurse Consultant : The Regional Nurse Consultant will be responsible ... the dissemination of expert advice and oversight to facility management personnel and line staff to ensure that systems...care facilities to ensure that the highest degree of quality care can be provided to the residents at… more
- CVS Health (Austin, TX)
- …external constituents in the coordination and administration of the utilization/benefit management function.* Meet set productivity and quality expectations ... meet operational needs. Specific schedules will bedeterminedin collaboration with management to ensure adequate weekend coverage.Position Summary:Utilize your clinical… more
- HCA Healthcare (Fort Walton Beach, FL)
- …you passionate about delivering patient-centered care?** Submit your application for Registered Nurse Lactation Consultant position and spend more time at the ... clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at HCA...your career! We are interviewing candidates for our Registered Nurse Lactation Consultant opening. **Apply today and… more
- CVS Health (Columbus, OH)
- …we do it all with heart, each and every day. **Position Summary** _Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and ... other products, services and/or programs + Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and… more
- CVS Health (Phoenix, AZ)
- … organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high- quality healthcare 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 forefront of clinical… more
- First Atlantic Health Care (Portland, ME)
- …Learn more about us at https://pcalmaine.com/ POSITION SUMMARY The RN Consultant assists the administrator by performing administrative responsibilities in the ... delivery of care. Meets the responsibilities of the RN Consultant as outlined in the state regulations. The RN...have received appropriate training, orientation, and evaluation to deliver quality care. + Assures all nursing personnel promote and… more
- Actalent (Des Moines, IA)
- Remote HEDIS Nurse Consultant Description HEDIS work typically includes requesting records, abstracting/overreading medical records, performing claims research, ... guidelines Remain current and consistent with the standards pertinent to the Quality Management team Qualifications * Active and Unrestricted RN License with 4+… more
- Philips (Utica, NY)
- **Clinical Solution Consultant - Upstate New York** Bring your passion for patient care and technology to this role where you'll be responsible for providing ... and delivery of Philips Hospital Patient Monitoring (HPM) products to ensure a quality customer experience. **Your role:** + Serving as a clinical resource to… more