- CVS Health (Carson City, NV)
- …cardiology **Preferred Qualifications** -1+ years' experience in either Precertification or Utilization Review -1+ years' experience Managed Care -Strong ... it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in PST… more
- Alameda Health System (San Leandro, CA)
- …Follows AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization...EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in… more
- Rochester Regional Health (Rochester, NY)
- …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... Job Title: Registered Nurse I Department: Utilization Management Location:...40 hours (Full-Time) Schedule: Monday - Friday, Days SUMMARY: Review all inpatient medical necessity denials for the health… 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 ... accordance with established SOP procedures. 9. Maintains current knowledge of hospital utilization review processes and participates in the resolution 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 Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Hartford HealthCare (Willimantic, CT)
- …clinical nursing required. * Two years experience with case management, discharge planning, utilization review and/or home care required. * Knowledge of the ... is*your moment.* **Job:** **Nursing* **Organization:** **Windham Hospital* **Title:** *Registered Nurse Case Manager (RN) - Utilization Management* **Location:**… more
- McLaren Health Care (Flint, MI)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... and more satisfying lives. We are looking for a Utilization Management RN, to join in leading the organization...care, disease management and PCP treatment plans. Monitors member's utilization patterns for identification of high risk, and under… more
- CVS Health (Baton Rouge, LA)
- …heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts high-acuity, timely, ... ensuring data integrity and compliance. * Participate in quality improvement, policy review , and education related to NICU and special populations utilization … more
- CVS Health (Baton Rouge, LA)
- …do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts high-acuity, ... systems, ensuring data integrity and compliance. * Participate in quality improvement, policy review , and education related to utilization management. * Serve as… more
- Sanford Health (Rapid City, SD)
- …Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven ... One year of leadership/management experience preferred. Experience in medical necessity review preferred. Currently holds an unencumbered registered nurse (RN)… more