- Sanford Health (Rapid City, SD)
- …preferred. Experience in medical necessity review preferred. Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management ...Nursing and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains… more
- Baystate Health (Springfield, MA)
- …- $62.85 **Per Diem Hospital Case Manager / Utilization Management ** The ** RN Hospital Case Manager** is a registered nurse responsible for the ... and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers… more
- Cognizant (Salem, OR)
- …have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **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
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
- Katmai (Fort Carson, CO)
- …Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted ... Registered Nurses ( RN ) licensed in Colorado, be...checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- CVS Health (Columbus, OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- CVS Health (Frankfort, KY)
- …behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse ( RN ) with active current and unrestricted Kentucky ... every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in...OR Minimum of an Associate's in Nursing or Diploma RN for Registered Nurses **Anticipated Weekly Hours**… more
- UNC Health Care (Smithfield, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a ... Registered Nurse with us, you'll have the...for case management scope of services including: Utilization Management services supporting medical necessity and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Barnstable counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more