- CVS Health (Carson City, NV)
- …And we do it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in ... holiday per year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate,… more
- McLaren Health Care (Port Huron, MI)
- **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay Period:** 40 **Position Summary:** Responsible for determining the ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- McLaren Health Care (Flint, MI)
- …to help people live healthier and more satisfying lives. We are looking for a Utilization Management RN, to join in leading the organization forward. MHP is a ... our members. **Position** **Summary:** This position is responsible for utilization management functions. This includes but is... functions. This includes but is not limited to review and authorization of services, utilization of… more
- Alameda Health System (San Leandro, CA)
- …identified fields in EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in a professional ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA...(Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of… more
- CVS Health (Baton Rouge, LA)
- …Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + Monitor team ... we do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer Success Organization who will provide clinical ... best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as...acute care setting + 2+ years of experience in utilization management + Knowledge and understanding of… more
- CVS Health (Phoenix, AZ)
- …in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes + Demonstrate making ... difference in the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part of a mission-driven team that's transforming… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
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