- AmeriHealth Caritas (LA)
- …company holidays and 1 to 2 weekends per year **Education & Experience** + Registered Nurse candidates: Associate Degree in Nursing (required) or Bachelor Degree ... Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity… more
- Centene Corporation (New York, NY)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... on workplace flexibility. **Must have an active New York State RN license.** **Inpatient Utilization Management** **Position Purpose:** Supervises Prior… more
- CVS Health (Phoenix, AZ)
- …for 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....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- AmeriHealth Caritas (Lafayette, LA)
- …fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse ( RN ) license in Louisiana or multi state license ... will also be counted upon to: **Work Arrangement:** + Remote role requiring residency in Louisiana. + Availability to...organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems (eg, JIVA) to efficiently… more
- Providence (Beaverton, OR)
- …in the collaboration and management of patient care + Current unencumbered Registered Nurse License in state of residency **Preferred qualifications for ... + Bachelor's Degree in Nursing or Health Education + Upon Hire: Current unencumbered Registered Nurse License in Oregon + Within six months of hire date:… more
- AmeriHealth Caritas (Washington, DC)
- …(BSN) preferred + Minimum of 3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department (ED), ... reviews within a managed care organization preferred **Licensure** + Active and unencumbered Registered Nurse license in the District of Columbia + Valid and… more
- Molina Healthcare (San Antonio, TX)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Salt Lake City, UT)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- CVS Health (Harrisburg, PA)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical...and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with… more
- CVS Health (Albany, NY)
- …all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state ... Friday, 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of… more