- Humana (Lincoln, NE)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Humana (Lansing, MI)
- …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization ...business administration. **Additional Information** + **Workstyle:** This is a remote position. + **Travel:** Up to 25% travel may… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management , discharge planning, care coordination, clinical ... Mobile, and Resident personas. This position can be fully remote , with the expectation to work in our Hingham...and gender affirming health, preferred. + 2-3 years of Utilization Management experience. + Active licensure in… more
- CVS Health (Columbus, OH)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Appeals Nurse ... with possible weekends based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN … more
- CVS Health (Phoenix, AZ)
- …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 ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks...with all policies and standards **Candidates must have a Registered Nurse ( RN ) license for… more
- CVS Health (Phoenix, AZ)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and ... shifts: 9:00am-5:30pm, 9:30am-6:00pm, 10:00am-6:30pm, or 11:30am-8:00pm EST Hours) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH),… more
- Martin's Point Health Care (Portland, ME)
- …3 years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting required + Leadership ... The Supervisor is responsible for day-to-day operations of the utilization review team, which includes clinical and non-clinical staff,...and/or management experience preferred Required License(s) and/or Certification(s): + Current… more
- Molina Healthcare (Spokane, WA)
- … licensure required **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ... Clinical Services Auditor performs auditing of clinical staff in Utilization Management (UM), Case Management ...them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more