- Dignity Health (Bakersfield, CA)
- …criteria used for decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider to validate ... levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for physician review based… more
- Dignity Health (Bakersfield, CA)
- …with each and every internal and external customer. - Perform all functions of the UM nurse reviewer. - Composes denial letter in a manner consistent with ... hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for...LVN Program. - Clear and current CA Licensed Vocational Nurse (LVN). - Knowledge of nursing theory and ability… more
- Magellan Health Services (Boise, ID)
- …but ASN considered with additional experience. Thorough knowledge of physical, medical specialty and/or mental health community resources and providers. Thorough ... knowledge of healthcare services in physical health, behavioral health or other medical specialty area based on pod management. Considerable skill in interpreting… more
- Magellan Health Services (Boise, ID)
- …services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. + Provides telephone triage, crisis intervention and ... of treatment when requests for services do not meet medical necessity criteria. + Participates in network development including...quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience… more
- Trinity Health (Darby, PA)
- …within an assigned caseload and collaborates with the healthcare team to confirm medical necessity for admission and continued stay. **What You Will Do** + Perform ... support efficient patient care delivery. + Apply InterQual criteria to confirm medical necessity for inpatient admission and continued stay. + Collaborate with… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... Clinical Reviewer will assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative… more
- CVS Health (Columbus, OH)
- …the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Medical Review, you'll play a ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- CVS Health (Phoenix, AZ)
- …lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Oncology and Transplant, you'll play a ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,...year of experience in Oncology and Transplant either in UM , concurrent review, or prior authorization + 3+ years… more
- Integra Partners (Troy, MI)
- …manager for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse Team Lead's responsibilities include but are ... The Utilization Management ( UM ) Nurse Supervisor is responsible for...as needed, utilizing federal/state mandates, plan benefit language, and medical necessity criteria (eg, InterQual, CMS, health plan policies).… more
- LA Care Health Plan (Los Angeles, CA)
- …of direct patient care that may include at least 2 years of relevant Licensed Vocational Nurse (LVN) experience in a UM or CM capacity substituted for 1 year of ... Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department:...adhere to regulatory mandates that apply to Utilization Management ( UM ) and Care Management (CM). This position is responsible… more