- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... of clinical oversight and leadership to Utilization Management/Case Management ( UM /CM) staff working with the children's population. + Develops, implements,… more
- AmeriHealth Caritas (Lafayette, LA)
- …perform a thorough medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information and/or request clarification. ... The BH UM Reviewer will use his/her professional judgment to evaluate...2 weekends per year. **Education & Experience:** + Registered Nurse candidates: Associate Degree in Nursing (required) or Bachelor… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …closely with physician advisors, case management, and revenue cycle teams. The UM Analyst helps ensure regulatory compliance, timely appeals, and reduction of ... contacts, and changes supporting a denials prevention program * Collaborate with UM staff to review for medical necessity and authorization-related denials to… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management ( UM ) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... drive day to day operations and oversight of the UM program. + Lead, develop and manage processes to...Qualifications + Active and unrestricted license as a Registered Nurse (RN). + Bachelor's degree in nursing, (or equivalent… more
- CVS Health (Buffalo Grove, IL)
- …you will help establish and implement processes to ensure utilization management ( UM ) programs are compliant and supportive of regulatory and PBM pharmacy ... the impact of new regulatory guidance and requirements on UM criteria. Knowledge of regulations impacting UM ...or NYC office locations. **Required Qualifications** + Active Registered Nurse (RN) Licensure in good standing + 5+ years… more
- HCA Healthcare (Englewood, CO)
- …o Current licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure, or LCSW required. o BLS ... certification through American Heart Association or American Red Cross required. o UM /CM certification preferred. B. Education: o Graduate of an accredited school of… more
- Alameda Health System (Oakland, CA)
- …a Registered Nurse in the State of California. Preferred Licenses/Certifications: UM / CM certifications Alameda Health System is an equal opportunity employer ... direction of utilization practices; assists physicians and hospital personnel in understanding UM matters. + Perform all other duties as assigned. + Prepares cost… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Neonatal Intensive Care Unit* *University of Maryland St Joseph's Medical Center ( UM -SJMC) * *I. GENERAL SUMMARY* The Department of Pediatrics, University of ... seeks a mid-career or senior level Neonatologist to join UM -SJMC as the level III NICU Medical Director. This...Towson, MD * Staffed with 24 /7 and Neonatal Nurse Practitioners * TeleHealth Support 24/7 from the UMMC… more
- Molina Healthcare (Everett, WA)
- …a WA state LPN licensure. Candidates with case management, Utilization Management ( UM ), and direct managed care experience are highly preferred. Further details to ... teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other...Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or… more
- Sharp HealthCare (San Diego, CA)
- …Time** Bachelor's Degree in Nursing; Bachelor's Degree; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Professional in ... Or + Bachelor's Degree in Healthcare Administration. + California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED **Preferred Qualifications**… more