- Aequor (New York, NY)
- …an occupational nursing professional Minimum experience of 1-3 years in case management , utilization review and/or quality assurance Experience in episodic care, ... Job Description: Position Purpose: Provide clinical services to employees within regulated scope of...employees within regulated scope of practice and disability case management . Experience/Education: MS/NP in nursing degree and current NP… more
- The University of Vermont Health Network (Plattsburgh, NY)
- …summarization supports the Medical Center's performance improvement/quality program, risk management , clinical pathway development and outcome measurement using ... Unit Description: The Utilization Review Team monitors, collects and analyzes data...collects and analyzes data and evaluates variances of resource utilization , complications and overall quality of care based on… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …and regulations, clinical practice guidelines, and quality issues related to utilization management with application for appeals and denials management . ... of employee health documents and reports. The manager is a registered professional nurse manager who is responsible for conducting inpatient Care Management ; and… more
- CHRISTUS Health (Alamogordo, NM)
- …screening, monitoring, and reporting individual cases and/or trends to the infection control nurse . Performs utilization management functions as required by ... Description Five years recent relevant clinical experience in an acute care facility required....payer source. Complies with the Utilization Management Plan. Requirements Education Required: Associate… more
- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work... Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge,… more
- CVS Health (Raleigh, NC)
- …convenient and affordable. Position Summary Precertification (Infertility): Utilization Management Nurse Consultant + Utilizes clinical experience ... needs + MS Office suites experience Preferred Qualifications + Precertification/ Utilization Management experience preferred + Infertility experience preferred… more
- CVS Health (Austin, TX)
- …more personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience and ... EST zone (twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience + MedCompass Education… more
- CVS Health (Raleigh, NC)
- …the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant...to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical … more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN)...Relevant experience. Required + Experience in utilization management , case management , or clinical ... effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Job Summary: Our Utilization Management Appeals Nurse -… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ... reporting/analytics for UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration with… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- McLaren Health Care (Detroit, MI)
- …with an acute care hospital** _Preferred:_ + Experience in utilization management /case management , critical care, clinical documentation, or patient ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement… more
- CVS Health (Plantation, FL)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Utilizes clinical experience and skills ... (not all encompassing): -Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization , facilitates safe… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...Nursing Experience Required: At least 5 years of varied clinical experience in an acute hospital setting. At least… more
- CVS Health (Baton Rouge, LA)
- …Qualifications + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + 5+ years ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical...of equipment experience including phone, computer, and clinical documentation systems + A Registered Nurse … more
- Humana (Tallahassee, FL)
- …community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to support the coordination, ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...a year. The Utilization Management Nurse 2 Front End Review uses clinical … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level...within managed care setting. + 3+ years experience in clinical nurse setting preferred. + TPA Experience… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote ... 4:30pm Eastern Standard Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process to… more
- CVS Health (Columbus, OH)
- …and deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote ... pm EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to… more
