- CVS Health (Raleigh, NC)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant...Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience… more
- CVS Health (Raleigh, NC)
- …live in any state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... and deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote… 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
- Humana (Richmond, VA)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge, communication skills, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… 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 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… 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 ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... of services and care. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse Job...of case management and UR concepts + Utilization review of prior authorizations for medical ... physicians and other team members on issues related to utilization review (UR) including appropriate admissions and...and appropriate length of stay. Hard Skills + Active nurse licensure in the state of FL + Knowledge… more
- Insight Global (Philadelphia, PA)
- …A Healthcare Insurance company local to Philadelphia PA is looking to hire a Utilization Management Nurse (RN) to their delegation oversight & assessment ... license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or medicare/medicaid Experience/knowledge… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to support ... in Florida) Available to work 2 Holiday a year. The Utilization Management Nurse 2 Front End Review uses clinical knowledge, communication skills, and… 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. ... Job Summary: Our Utilization Management Appeals Nurse -...requirements, including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies to physician reviewers for… more
- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance ... and send to me with QB - 4-5 years of Remote Utilization Management experience at Payors, inpatient or outpatient - Proficiency… more
- CVS Health (Baton Rouge, LA)
- …Required Qualifications + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience and skills in… more
- CVS Health (Columbus, OH)
- …and unrestricted RN licensure in state of residence - Must have previous inpatient utilization review experience - Must be able to work Monday through Friday ... in multiple IT platforms/systemPreferred Qualifications - Knowledge of Medicare/Medicaid - Utilization Review experience preferred - Managed care experience -… more
- CVS Health (Lansing, MI)
- …includes navigating multiple systems and keyboarding Preferred Qualifications: - Managed care/ utilization review experience preferred - Ability to multitask, ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications: - Must have active,… more
- CVS Health (Phoenix, AZ)
- …and services both inpatient and outpatient services requiring precertification. + Utilization Management nurses use specific criteria to authorize ... providers. Required Qualifications + 1+ year: Oncology and Transplant UM, concurrent review or prior authorization + 3+ years: acute clinical Oncology or… more
- CVS Health (Columbus, OH)
- …in New Albany OH, Chandler AZ or High Point NC. Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... coordinating all case management activities with members to evaluate the medical needs...care innovators.Fundamentals:Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ... participation in and follow up of Utilization Management audits, such as readiness review , Data...Utilization Management audits, such as readiness review , Data Validation, CMS Program Audit and Compliance/Internal audits,… more
- University of Rochester (Rochester, NY)
- Responsibilities **General Description:** The Utilization Management Nurse role is a unique and exciting opportunity that blends the knowledge of nursing and ... work is remote with some on-site requirements as needed. **Qualifications:** RN with Utilization Review experience preferred; 3-5 years of recent acute hospital… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more