- Elevance Health (Indianapolis, IN)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... **Title: Utilization Management Representative I** **Virtual:** This role enables...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Elevance Health (Costa Mesa, CA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location** : This role...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Elevance Health (West Des Moines, IA)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... ** Utilization Management Representative II** **Location:** The selected candidate...Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- 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
- 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
- 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
- Ventura County (Ventura, CA)
- …candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of experience ... and review ; + Performs daily clinical reviews to support utilization and quality management, ensuring compliance with guidelines and standards for patients… more
- ChenMed (Houston, TX)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more