- CVS Health (Columbus, OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... 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
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- McLaren Health Care (Bay City, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... **Three years of acute hospital care experience** _Preferred:_ + Experience in utilization management /case management , critical care, or patient… more
- UNC Health Care (Kinston, NC)
- …applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management , or compliance experience preferred. + Minimum ... to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying… more
- Cedars-Sinai (Los Angeles, CA)
- …has named us one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & ... Coordination **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case Manager... Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- Elevance Health (Mendota Heights, MN)
- ** Nurse Reviewer I** **Location:** This role...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... Monday - Friday (9:30 AM -6:00 PM Centeral) The ** Nurse Reviewer I** is responsible for conducting...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… more
- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems....departments, and others whose support is necessary for the management and success for the program. . Serves as… more
- Nuvance Health (Poughkeepsie, NY)
- …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management ,… more