- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays...vital role in ensuring the delivery of high-quality, evidence-based care . This position is responsible for reviewing and evaluating… more
- Dignity Health (Bakersfield, CA)
- …experience. - Graduate of an accredited RN Program. - Clear and current CA Registered Nurse ( RN ) license. - Knowledge of nursing theory and ability to ... customer service in line with CommonSpirit's values. You will function as a UM nurse reviewer, applying clinical expertise to ensure appropriate healthcare… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse I Department: Utilization Management...for all payers. Demonstrates fiscal responsibility. + Prepare the UM review findings, initiate and 1st, 2nd,… more
- Health Care Service Corporation (Downers Grove, IL)
- …health needs within the scope of their benefit plan. **Required Job Qualifications:** + Registered Nurse ( RN ) with current, valid, unrestricted license to ... **Job Summary** This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning… more
- Elevance Health (Cerritos, CA)
- **Behavioral Health Care Manager II, UM ** **Location:** California **Virtual:** This role enables associates to work virtually full-time, with the exception of ... 8:30 am - 5:00 pm PST The **Behavioral Health Care Manager II** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . This role is a part of the team… more
- Trinity Health (Columbus, OH)
- …as appropriate. Assists in the implementation of Case Management software along with the Plan's UM and QM Program and the review of the Plan's Medical Management ... United States. We're dedicated to providing excellent customer service, cost-effective care , and exceptional healthcare coverage. We rely on talented colleagues in… more
- Healthfirst (NY)
- …or equivalent work experience + NYS RN + Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations ... concurrent review , and service requests + Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Preferred: + Master's Degree. Licenses and Certifications Preferred: NJ State Professional Registered Nurse License or NJ Licensed Social Worker. 175164 Minimum ... knowledge and understanding of behavioral health resource management to review and coordinate the care for a...care . Education, Knowledge, Skills and Abilities Required: + RN , BSN, or Bachelors degree in a clinical field… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Ambulatory Care Nurse Resource Pool-Cancer Center Cluster) Apply Now **Mission Statement** Michigan Medicine improves the health of ... equal employment opportunity employer. **Job Detail** **Job Opening ID** 272501 **Working Title** REGISTERED NURSE (Ambulatory Care Nurse Resource… more
- University of Michigan (Ann Arbor, MI)
- …Nurse Recruitment at ###. **Required Qualifications Current Michigan Registered Nurse License. 12-24 months of current PICU RN experience PALS ... to deliver the safest and highest quality of health care . Applicants are expected to review the...**Job Opening ID** 272704 **Working Title** REGISTERED NURSE (Mott Childrens Hospital-10W, Pediatric Cardio Thoracic Intensive Care… more