- Commonwealth Care Alliance (Boston, MA)
- 011330 CCA-Clin Operations & Implementation **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... and presents results. + Develops and analyzes quantitative reports to assess utilization , productivity and adherence to policies and procedures related to various… more
- Cognizant (Carson City, NV)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Baton Rouge, LA)
- …years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
- Molina Healthcare (GA)
- …experience. * At least 1 year of health care management /leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
- CVS Health (Little Rock, AR)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... needed. + 3+ years inpatient clinical experience as a Registered Nurse . + 3+ years of Managed...years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership… more
- Molina Healthcare (GA)
- …and experience. * At least 3 years health care management /leadership required. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
- Humana (Little Rock, AR)
- …and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Tufts Medicine (Burlington, MA)
- …of Science in Nursing (BSN). 2. RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case ... review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization … more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in… more
- Actalent (Santa Barbara, CA)
- Remote Utilization Management RN Leading...team + Fully remote !! REQUIREMENTS: + California Registered Nurse ( RN ) and/or ... soon as possible! Description: + REMOTE + RN with experience in providing Case Management ...alpha resource center, parents helping parents, etc. knowledge of Utilization Management process/ turnaround times. + Familiar… more
