- CVS Health (Lansing, MI)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... promote high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant,...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- 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 Manager and...Nursing and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Preferred: 1. Not Applicable. Licenses and Certifications Required: 1. NJ State Professional Registered Nurse License. 2. Advance Practice Nurse License. 3. ... **The Per Diem Advanced Practice Nurse (APN) for Utilzation Review utilizes a patient-centered coordinated care model, demonstrating competencies in leadership,… more
- Molina Healthcare (Orem, UT)
- 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 connectivity ... (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
- Fallon Health (Worcester, MA)
- …degree in nursing required **License/Certifications:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** * A minimum of ... eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review ...three to five years clinical experience as a Registered Nurse in a clinical setting required.… more
- Dignity Health (Bakersfield, CA)
- …experience. - Graduate of an accredited RN Program. - Clear and current CA Registered Nurse ( RN ) license. - Knowledge of nursing theory and ability to ... **Job Summary and Responsibilities** As a Utilization Management RN , you will be...with CommonSpirit's values. You will function as a UM nurse reviewer , applying clinical expertise to ensure… more
- Houston Methodist (Houston, TX)
- …HMWB (Willowbrook) HMTW (The Woodlands), HMSL (Sugar Land), HMCY (Cypress) At Houston Methodist, the Registered Nurse ( RN ) PRN position is a licensed staff ... prioritize daily tasks. Provides input into the unit resource utilization including unit capital and operational budget needs. +...a healthcare environment **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- WestCare Foundation (Henderson, NV)
- … RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric or ... substance use disorder Experience and Competencies: + Proven experience in conceptualizing a case and creating a clinical impression to present to all involved and approved parties, including managed care representatives + Knowledge of CPT, ICD 9 & ICD 10… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... outcomes and reducing readmissions. #LI-CC2 Qualifications Required qualifications: 1. CA Registered Nurse 2. Bachelor's of Science in Nursing3. Grandfathered… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible for… more