- CVS Health (Richmond, VA)
- …MS Office suites experience including Outlook and Excel **Preferred Qualifications** + Utilization Review experience + Managed Care experience + Strong customer ... we do it all with heart, each and every day. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote. As a Utilization … more
- AdventHealth (Daytona Beach, FL)
- …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. + ... 32117 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …or related field * Minimum 3 years of experience in clinical care, utilization review , case management, or clinical denials/appeals -OR- * An approved ... *_SUMMARY:_* We are currently seeking a Utilization Management Analyst to join our Denials Analysis....denials prevention program * Collaborate with UM staff to review for medical necessity and authorization-related denials to determine… more
- WMCHealth (Valhalla, NY)
- …implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical ... agency, one of which must have been in the area of utilization review , quality assurance, risk management or discharge planning. About Us: Westchester Medical… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ensuring… more
- Humana (Lincoln, NE)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Access Dubuque (Dubuque, IA)
- …Conduct reviews inclusive of physician referrals, medication reviews, admissions, utilization review updates, investigating alternatives to hospitalization such ... Utilization Management Nurse **Medical Associates** 1 Positions ID:...Dental Insurance, etc. **What You Will Be Doing:** + Review requests from providers or members for approval of… more
- Highmark Health (Olympia, WA)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- CVS Health (Columbus, OH)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days **including every ... UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience with LTAC, skilled rehab,… more