- CenterWell (Columbus, OH)
- …caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking ... your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non… more
- 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 ... denial notice for determination. - Escalates non-compliant cases to UM compliance and consistently reports on denial activities. -...LVN Program. - Clear and current CA Licensed Vocational Nurse (LVN). - Knowledge of nursing theory and ability… more
- Molina Healthcare (Oakland, CA)
- …Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as ... well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- CVS Health (Hartford, CT)
- …high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. **Key Responsibilities** ... of a computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity… more
- Adecco US, Inc. (Minneapolis, MN)
- …necessity and efficiency in accordance with CMS coverage guidelines. . The UM Nurse determines medical appropriateness of inpatient and outpatient services ... $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed hospitalization, home care, and… more
- CVS Health (Tallahassee, FL)
- …24/7 operation and work schedule may include weekends, holidays, and evening hours._ ** UM Nurse Consultant** Fully Remote- WFH **Position Summary** + Utilizes ... clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate… more
- CVS Health (Richmond, VA)
- …all with heart, each and every day. **Position Summary** The Utilization Management ( UM ) Nurse Consultant is a remote, full-time role responsible for evaluating ... the medical necessity and appropriateness of healthcare services using evidence-based clinical criteria. This position involves conducting utilization reviews, collaborating with healthcare providers, and supporting care coordination to ensure cost-effective… more
- CVS Health (Madison, WI)
- …periods of time, talking on the telephone, and typing on the computer. The UM Nurse Consultant utilizes clinical skills to coordinate, document and communicate ... all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services. + Utilizes clinical skills to… more
- AdventHealth (Glendale Heights, IL)
- …does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated ... 60139 **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical expertise by analyzing patient records… more
- University of Miami (Miami, FL)
- …this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . JOB DESCRIPTION UM Title: Senior Registered Nurse Supervisor's ... 2014. Job Summary (Purpose and Function): The Pain Management Nurse will be a professional registered nurse ...and variances to the plan of care. Documents in UM Care program intra-procedure assessment of patient condition. Planning… more
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