- 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 ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy +… 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 directors/physician reviewers, network physicians, and network facilities to...most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …is seeking a highly motivated and results-oriented **Utilization Management ( UM ) Nurse ** . Our ideal ** UM Nurse ** will ensure timely review of ... policy, regulatory, and Health Plan guidelines. + Apply case management skills to members who have been identified as...medical standards of practice or experience with using UM medical criteria (ie Milliman and InterQual)… 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 ... no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security** : Must possess… more
- Commonwealth Care Alliance (Boston, MA)
- …staff selection, training, and performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM program design, ... or Health related field preferred Required Licensing: - active RN license required Required Experience: - 7-10 years -...minimum five (5) years of leadership experience in Utilization Management ( UM ) or nursing leadership to include… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …18 month commitment before posting for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... BCBST as a Clinical Review Manager\!** In this role, you will complete medical reviews for utilization management within the BlueCare member population\. You'll… more
- Commonwealth Care Alliance (Boston, MA)
- …responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... Audits, or EQRO reviews). - Hire, train and mentor UM staff, including nurse reviewers and support...reviewers and support personnel. - Act as liaison with medical director, provider relations, case management and… 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 ... excellence. **Duties of a Care Manager in the Care Management Department may include the following but are not...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more
- Elevance Health (Las Vegas, NV)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Molina Healthcare (Springfield, MA)
- …Care Services business in Massachusetts. We are looking for a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience ... promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
