- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous...culture and much more. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Ascension Health (St. Charles, IL)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... **Details** + **Department:** Utilization Review + **Schedule:** Part-Time, Partially Remote...offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning, and utilization review. +… more
- Corewell Health (Grand Rapids, MI)
- …nursing and or case management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life Support (BLS) ... Monday, Tuesday, Wednesday, Thursday, Friday (4 hours), mostly remote , occasional on-site About the Department: RN UM...prior authorizations, initial reviews, continuous stay reviews and appeals. Nurse Care Manager - Plans and prioritizes care for… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all… more
- Centene Corporation (Sacramento, CA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Access Dubuque (Dubuque, IA)
- …Risk Management and Accreditation Program Manager UnityPoint Health Finley Hospital Utilization Management Nurse Cottingham & Butler/ SISCO CNA ... Utilization Management CNA **Cottingham & Butler/...will also triage the call to determine if a Utilization Review Nurse is needed to complete… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- State of Michigan (Lansing, MI)
- Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight Unit (FC-PMOU) Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/5143934) ... Apply Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight Unit...Biweekly Location Lansing, MI Job Type Permanent Full Time Remote Employment Flexible/Hybrid Job Number 3901-26-HSA-MCMCS-001-EST Department Health and… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more