- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state. **Normal Working Hours: Monday… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% ...Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state.… more
- CVS Health (Carson City, NV)
- …cardiology **Preferred Qualifications** -1+ years' experience in either Precertification or Utilization Review -1+ years' experience Managed Care -Strong ... with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully ...Utilization Management (UM) Nurse Consultant role is fully remote but must reside in PST zone.** Normal Working… more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- CVS Health (Baton Rouge, LA)
- …Responsibilities** + Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + ... do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... criteria + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency in MS Office to include… more
- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Ochsner Health (Jefferson, LA)
- …relationships, contract management, standardization and consolidation processes and utilization analysis. Reviews, analyzes, negotiates, and develops contractual ... product change and serves as an internal advocate of product standardization/ utilization initiatives; coordinates new product introduction and overall product change… more
- Liberty Healthcare Corporation (Salisbury, MD)
- …are living with developmental disabilities + Service coordination + Case management + Utilization review + Prior authorizations + Claims reviews + Healthcare ... this initiative, Liberty is now hiring for a full-time Utilization Reviewer position. As a Utilization Reviewer,...+ Reimbursement for approved work-related mileage This is a remote first position which will allow you to primarily… more