- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
- CVS Health (Columbus, OH)
- …utilization /benefit management function **Required Qualifications** + Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Elevance Health (Durham, NC)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more
- AmeriHealth Caritas (LA)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- AmeriHealth Caritas (Washington, DC)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- CVS Health (Richmond, VA)
- …of care, and appropriate discharge planning + Serve as the behavioral health subject matter expert to support care management staff in serving Aetna ... foster collaboration and provide education and training + Consults with Plan executive management regarding physical and behavioral health clinical issues as… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care for members who may ... provide the best quality care. The Team The RN Utilization Management Reviewer is part of a...dedicated and motivated team of professionals, including medical and behavioral health care managers, dietitians, pharmacists, clinicians,… more