- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses;...in a direct patient care clinical setting. Must have utilization management , utilization review… more
- CVS Health (Harrisburg, PA)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with MS office applications such… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Management NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization ... activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines + Medicaid… more
- CVS Health (Austin, TX)
- …operation. Work schedules may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant you will be responsible for ... Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...work Monday through Friday 8:00am to 5pm CST + Utilization management is a 24/7 operation. Work… more
- Humana (Tallahassee, FL)
- …put health first** Humana Healthy Horizons in Florida is seeking a Utilization Management Nurse (Front End Review ) who will utilize clinical nursing ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 's work assignments are varied… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Management Nurse in Houston, TX! This role is hybrid with a mix of work from home ... 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Management Nurse :** . Responsible...for Case Management and institutes a care management plan . Provides concurrent review on… more
- McLaren Health Care (Pontiac, MI)
- …requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or ... **Position Summary:** Responsible for Utilization and Care Management services to...on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …facilitates interdisciplinary team collaboration, from admission through discharge. He/she will review medical records and accurately document UM reviews in NUMI ... following the VACO UM process and the InterQual review process. He/she will facilitate and coordinate admissions to...and performance measures. He/she will utilize emergency and bed management software, along with UM data, to manage admission… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage ... with occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse (RN)...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more