- UnityPoint Health (Cedar Rapids, IA)
- …+ Maintains knowledge of utilization management criteria and communicates with UM Coordinator to ensure medical necessity and appropriate patient class for ... of Interest: Nursing + FTE/Hours per pay period: 1.0 + Department: Case Management + Shift: Monday-Friday, 1st shift. Occasional weekends. + Job ID: 174849 Overview… more
- Cleveland Clinic (Cleveland, OH)
- …+ Graduate of an accredited School of Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through the ... respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities,...Three years of equivalent full-time clinical experience as a Registered Nurse + Analytical ability required to… more
- HCA Healthcare (Englewood, CO)
- …Licensure/Certification/Registration: o Current licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure, or LCSW ... years UM /CM experience required. o One to three years charge/lead/supervisory/ management experience required, in UM /CM department role preferred. Able to… more
- AmeriHealth Caritas (LA)
- …opportunities and refer those cases to integrated care management as needed. The BH UM Reviewer will apply medical health benefit policy and medical ... company holidays and 1 to 2 weekends per year **Education & Experience** + Registered Nurse candidates: Associate Degree in Nursing (required) or Bachelor Degree… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... **PURPOSE** : Supervise the daily operations of the utilization management ( UM ) department functions to ensure appropriate...State Licensure. **Experience:** 3 years Medical /surgical experience including, but not limited to, inpatient care,… more
- Sanford Health (Sioux Falls, SD)
- …for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... level of care medical necessity reviews within patient's medical records. Performs utilization management ( UM ) activities in accordance with UM … more
- UNC Health Care (Morrisville, NC)
- …unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational leader responsible for ... goals. The Executive Director works closely with leaders from various departments-case management , physician advisors, revenue cycle, medical staff, nursing, and… more
- Saint Francis Health System (Tulsa, OK)
- …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or ... and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details… more
- Centene Corporation (New York, NY)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization… more
- CVS Health (Lansing, MI)
- …Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective ... computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more