- 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
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... We are looking for a Utilization Management RN, to join us in leading...care, disease management and PCP treatment plans. Monitors member's utilization patterns for identification of high risk, and under… more
- Omaha Children's Hospital (Omaha, NE)
- …opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management ... Guides admitting physician in protocols for conducting physician to physician review with third-party payers. o Appropriately documents all relevant communications… more
- CVS Health (Santa Fe, NM)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or...year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and… more
- CVS Health (Lansing, MI)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant - Oncology and Transplant to ... and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring… more
- Omaha Children's Hospital (Omaha, NE)
- …opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management ... Guides admitting physician in protocols for conducting physician to physician review with third-party payers. * Appropriately documents all relevant communications… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr CMC- Clear...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv....and current Texas Nursing licensure as a professional registered nurse . Minimum of three years of full time wage ... earning experience as a professional nurse in a health care setting. **JOB DESCRIPTION :**...criteria guidelines. **MAJOR DUTIES / CRITICAL TASKS:** + Implements Utilization review procedures by prospectively, concurrently, and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more