- Centene Corporation (Annapolis, MD)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... in accordance with regulatory guidelines and criteria. + Performs concurrent review of behavioral health (BH) inpatient...Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required Pay Range: $26.50 - $47.59 per hour… more
- CVS Health (AZ)
- …+ Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review , or prior authorization + 3+ years of experience in Acute clinical ... of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll play a vital role… more
- BrightSpring Health Services (Austin, TX)
- …Graduate of an accredited school/college with current registration of practice as a Registered Professional Nurse + Excellent communicator with ability to handle ... meetings + Chairing committees as appropriate, safety, infection control, incident review , and human rights committees + Facilitating communication and serving as… more
- CVS Health (AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... 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… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National certification ... *_SUMMARY:_* We are currently seeking a*Utilization Review Manager* to join ourTransitional Care Team.This is...and implements process to manage and respond to all concurrent and post-discharge third party payer denials of outpatient… more
- UTMB Health (Galveston, TX)
- …school of professional nursing and current Texas Nursing licensure as a professional registered nurse . Minimum of three years of full time wage earning ... experience as a professional nurse in a health care setting. **JOB DESCRIPTION :**...review of quality of care issues arising during concurrent review , identifies area of potential medical… more
- UCLA Health (Los Angeles, CA)
- …+ Graduate from an accredited school of nursing. BSN required. MSN preferred. + CA RN License + ACLS from American Heart Association or American Red Cross + Two-year ... previous charge RN or leadership + Knowledge of Cardiology and General...to represent the Medical Center in site visits and review by managed care, insurance groups, and regulatory entities.… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute...may reasonably be required._ **Education/Experience Required:** + Current MA RN licensure + Bachelor's Degree in Nursing or advanced… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...information to the department head as indicated. + Utilization review and utilization managementThe RN CM I… more
- Centene Corporation (Sacramento, CA)
- …duties as assigned + Complies with all policies and standards **Candidates must have a Registered Nurse ( RN ) license for California and ability to work in ... of related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or… more