- Brighton Health Plan Solutions, LLC (NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... coverage while working remotely. Primary Responsibilities * Performs clinical utilization reviews using evidenced based guidelines, policies and nationally… more
- Trinity Health (Albany, NY)
- …differences often lead to innovative solutions. **Registered Nurse Professional Utilization Management Nurse - St. Peter's Hospital--Full-TIme Days** ... **Description:** We at St. Peter's Health Partners recognize that nursing is one of the most challenging careers and...accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for… more
- Hackensack Meridian Health (Brick, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Trinity Health (Albany, NY)
- **Employment Type:** Part time **Shift:** 12 Hour Day Shift **Description:** **RN Utilization Management -Per diem** If you are looking for an RN position in ... accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for...valid NYS RN license + Bachelor of Science in nursing , or willingness to purse defined plan for matriculation… more
- CVS Health (Springfield, IL)
- …and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of ... it all with heart, each and every day. _Utilization Management is a 24/7 operation and work schedule may...to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Molina Healthcare (GA)
- …of healthcare services professionals in some or all of the following functions: utilization management , care management , behavioral health and other ... of the following key health care services functions: care management , utilization management , care transitions,...and experience. * At least 3 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- Omaha Children's Hospital (Omaha, NE)
- …employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management ... settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative,...Compact State Licensure Required and + RN-BC - Case Management Nurse Preferred Children's is the very… more
- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM...needed. + Minimum 5 years of relevant experience in Nursing . + Minimum 3 years of clinical experience in… more
- CVS Health (Little Rock, AR)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... + 3+ years inpatient clinical experience as a Registered Nurse . + 3+ years of Managed Care experience. +...years of Managed Care experience. + 3+ years of Utilization Management experience. + 1+ year Leadership… more