- CVS Health (Columbus, OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... sedentary work, including extended periods of sitting, computer use, and document review . + Participate in occasional on-call rotations, including some weekends and… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse...patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient… more
- Centene Corporation (Oklahoma City, OK)
- …Must reside in Oklahoma.** + **Conduct clinical reviews for medical necessity ( utilization review ).** + **Demonstrate strong provider relations skills.** + ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Centene Corporation (Denver, CO)
- …to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence letters with the ... and NCQA standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure compliance with all applicable State and Federal… more
- Centene Corporation (Des Moines, IA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Ventura County (Ventura, CA)
- …direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, and quality improvement functions to ensure ... Duties may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and… more
- System One (Baltimore, MD)
- Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224 Type: Contract, 5 mos with chance of extension Compensation: Based on experience starting ... occassional travel to providers for record retrieval, as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist Schedule: 8-hour shifts… more
- Hartford HealthCare (Manchester, CT)
- …Region serves a region of 300,000 people in 19 towns. POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician ... progression of care in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical standards, ie, InterQual,… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse (RN) - Case Manager - 2506003285 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with ... to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to… more