- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members ... of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a highly dedicated and motivated team of… more
- Molina Healthcare (GA)
- …or more of the following activities: care review , care management , utilization management (prior authorizations, inpatient/outpatient medical necessity, ... professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term services and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Humana (Lincoln, NE)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote. As a ... to coordinate, document and communicate all aspects of the utilization /benefit management program and our plan sponsor(s)....and Word -Strong telephonic communication skills -1+ years of Utilization Review experience -1+ years of Managed… more
- Common Ground (Flint, MI)
- Exciting Career Opportunity! The Behavioral Health Utilization Management (UM) Specialist is responsible for reviewing and evaluating mental health and substance ... + 2+ years in behavioral health clinical practice and/or utilization management . + Minimum of 3 years...(QIDP) defined by the State of Michigan + Certified Utilization Review Professional (URAC), CCM, or similar… more
- AdventHealth (Orlando, FL)
- …creating a holistic environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise ... reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. +… more
- Brighton Health Plan Solutions, LLC (NC)
- …Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… more