- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- CVS Health (Austin, TX)
- …in clinical setting with diverse cultural dynamics of clinical staff and patients. Registered Nurse ( RN ) required. Licensed Clinical Social Worker (LCSW) ... care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care +… more
- TEKsystems (Los Angeles, CA)
- …for a Licensed Vocational Nurse (LVN) or Registered Nurse ( RN ) with hands-on experience in Utilization Management (UM) and a strong understanding of ... Location: West Hills/Canoga Park 91305 Compensation: LVN $38-$40 hourly RN $45-$50 hourly Overview: The Retro Claims Reviewer is...provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible for… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and...Required + Must be licensed to practice as a Registered Nurse in the state of North… more
- CVS Health (Baton Rouge, LA)
- …Responsibilities** + Lead, coach, and develop a multidisciplinary team responsible for utilization review , prior authorization, and case management functions. + ... do it all with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to… more
- Sanford Health (Rapid City, SD)
- …patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and appropriate level of care for patients ... and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of...two years' clinical experience preferred. Currently holds an unencumbered RN license with the State Board of Nursing where… more
- Humana (Jackson, MS)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… 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. ... the Emergency Department). Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State ofCalifornia.\ Pay Range $89.32-… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness...State of PA RN licensure OR Current… more