- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Cognizant (Annapolis, MD)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Banner Health (Phoenix, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... better nursing. Our Care Management staff is seeking an RN Case Manager to work closely with members seeking...telephonic, home visits, and televisit platforms. It is fully remote with the exception of a few in person… more
- Bon Secours Mercy Health (Norfolk, VA)
- …clinical and operational excellence. **Summary of Primary Function** In the capacity of a Registered Nurse ( RN ), the Ambulatory Care Manager will provide ... Nursing Bachelor's Degree (preferred) Specialty/Major- Nursing (BSN) **Licensing/ Certification** Registered Nurse with active License in State of… more
- TEKsystems (Canoga Park, CA)
- …communication and analytical skills. Position: Utilization Review Nurse Work Environment: Hybrid (onsite & remote ) Schedule: Full-time, Monday-Friday, ... the Role We are seeking a detail-oriented and experienced RN or LVN with an active license to join our team as a Utilization Review Nurse . In this role,… more
- Tufts Medicine (Melrose, MA)
- …role is essential in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with ... managers, TMIN Practice Optimization Coaches (POMs) and primary care providers to review patient records, analyze data, and identify practice and patient outlier … more
- CVS Health (Austin, TX)
- …it all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse ( RN ) position is with Aetna's National Medical Excellence ... to apply, however, preference is for candidates in compact Registered Nurse ( RN ) states. This...is a blended role doing both Case Management and Utilization Management. The RN Case Manager is… more
- Saint Francis Health System (Tulsa, OK)
- …from ER, ICU, and CTU units. + All private rooms Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the ... therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related… more
- US Tech Solutions (Columbia, SC)
- …3 years clinical experience or 2 years clinical experience plus 1 year utilization /medical review , quality assurance, or home health. **Skills:** + Working ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...and if progressing well, can be moved to work remote . + Prefer 2 yrs. UM and/or appeals experience.… more