- Providence (OR)
- …in the collaboration and management of patient care + Current unencumbered Registered Nurse License in state of residency **Preferred qualifications for this ... in Oregon + Within six months of hire date: Current unencumbered Registered Nurse License in Washington State + Case Management Experience (EX. Triage and… more
- Intermountain Health (Las Vegas, NV)
- …+ Continuous Improvement + Scheduling **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of practice ... work and complex care planning, transitions of care, and utilization management . The position ensures compliance with...+ Occasional weekend or holiday coverage + Possibility of remote work some days + Main Location - Nevada… more
- Texas Health Resources (Arlington, TX)
- …Management required 3 years previous leadership experience required Licenses and Certifications RN - Registered Nurse Current license to practice ... Director Utilization Management -Clinical Review _Are you looking...Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote /onsite. Vast majority of time will be remote… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. + 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. + ... in nursing required** **License/Certifications** + Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience** + A minimum of three… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Centene Corporation (Jefferson City, MO)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... Complies with all policies and standards. **This is a remote position. Ideal candidate will be located in eastern...in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an… more
- St. Luke's University Health Network (Allentown, PA)
- …hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial experience related ... regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and… more
- CVS Health (Springfield, IL)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...schedule may include weekends, holidays, and evening hours._ Fully Remote - WFH **Position Summary** + Utilizes clinical experience and… more
- CDPHP (Latham, NY)
- …New York State license is required) + In lieu of behavioral health license, Registered Nurse with valid New York State license, with experience treating ... alternative services to the medical directors. This position is remote with the potential for meetings on-site at CDPHP...a hospital setting required. + Minimum one (1) year quality/ utilization management experience in health care setting… more