- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to establish the most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process changes + Maintains… more
- ERP International (Hurlburt Field, FL)
- **Overview** ERP International is seeking a full time ** Registered Nurse ( RN ) Case Manager** in support of the 1st Special Operations Medical Group at ... Management Specialist (CDMS) Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) American Board for Occupational Health… more
- ERP International (Twentynine Palms, CA)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Case Managers** for full-time positions in support of the **Naval Hospital Twentynine ... Management Specialist (CDMS) o Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) o American Board for Occupational Health… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker ... for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case management with social work...or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security**… more
- Stony Brook University (Stony Brook, NY)
- …and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history ... RN Case Manager **Position Summary** At Stony Brook...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more
- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. - Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...or Health related field preferred Required Licensing: - active RN license required Required Experience: - 7-10 years -… more
- Molina Healthcare (Syracuse, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical...intensive care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours: Monday… more
- UPMC (Pittsburgh, PA)
- UPMC Home Health is Hiring a Full-Time Registered Nurse ( RN ) for the Uniontown and Surrounding Areas Are you a nurse looking for a rewarding career where ... care in the comfort of their homes. As an RN with UPMC Home Health, you'll collaborate with our...Licensure, Certifications, and Clearances: + Current licensure as a Registered Professional Nurse either in the state… more
- Molina Healthcare (Salt Lake City, UT)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours:… more
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