- Centene Corporation (Sacramento, CA)
- …a fresh perspective on workplace flexibility. Remote position. Must work PST ** RN -Must hold a current CA license.** **Must have** **5-7 years related** **experience ... in UM -Concurrent Review. 2+ years of acute care experience required....management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + For Health Net… more
- US Tech Solutions (Columbia, SC)
- …the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech ... week. + M-F 8:30am - 5pm. + From the Manager: -Experience: Hospital experience, UM experience -Description: office work, at a desk 8 hours per day, reading clinical… more
- Actalent (Des Moines, IA)
- Job Title: Post Review Nurse - Utilization Management Job Description We are seeking a diligent and detail-oriented Post Review Nurse to perform timely ... collaboration across divisions. + Provide backup support to other UM teams, including precertification and continued stay reviews. +...HIPAA, ICD, and CPT. + Completion of an accredited RN or LPN program. + Active, unrestricted RN… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... other functions as assigned by management. Minimum Qualifications: + RN with valid and current NYS Nursing Licensure. +...understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three… more
- University of Michigan (Ann Arbor, MI)
- …they have proper supply and preference lists & coordinate corrections with the RN Leads for each surgical service + Run reports, verify information, investigate ... Time** Part-Time **Regular/Temporary** Regular **FLSA Status** Nonexempt **Organizational Group** Um Hospital **Department** MM Oper Rooms - Univ Hospital **Posting… more
- Commonwealth Care Alliance (Boston, MA)
- …Translate regulatory updates into operational actions, collaborating with Claims, Appeals, UM , and Provider Services. * Conduct internal audits and retrospective ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Sr. Medical Director of Utilization Management ( UM ) and Policy, the Medical Policy Director, provides strategic and tactical ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
- Elevance Health (Indianapolis, IN)
- …necessaryquality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... provide an equivalent background. + **Current, active, unrestricted license such as either:** ** RN (** **must have exp, in behavioral health** **) LCSW LMSW LMHC LPC… more
- Elevance Health (Washington, DC)
- …improvement strategies. + Hires, trains, coaches, counsels, and evaluates performance of both UM + Assists and provides back up coverage to Case Management team ... which includes 3 years prior management experience + Current active unrestricted RN license in the District of Columbia is required. **Preferred Qualifications:** +… more
- University of Michigan (Ann Arbor, MI)
- …Group** Um Hospital **Department** MM UH CVC Care Mgt RN **Posting Begin/End Date** 8/21/2025 - **Salary** $43,680.00 - $56,014.40 **Career Interest** ... Service Employees Intl Union (SEIU) Apply Now more