- Molina Healthcare (Boston, MA)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support...with a MA RN licensure. Candidates with UM Medical Review background and experience using… more
- 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
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. + Document review … more
- 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 ... timely clinical and service authorization review for medical necessity and decision-making. The ...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance… more
- AdventHealth (Daytona Beach, FL)
- …PKWY, Daytona Beach, 32117 **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse ( RN ) is to use clinical expertise ... legitimacy of hospital admission, treatment, and appropriate level of care . The UM RN leverages...+ Current and valid license to practice as a Registered Nurse (ADN or BSN) required. +… more
- Magellan Health Services (Boise, ID)
- …- Care MgmtCare Mgmt, PC - Professional Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... development and on-going management of designated staff. + Performs care management review activities consistent with Magellan...required: BCBA, LCSW, LMFT, LMSW, LPCC, LPC, PC or RN . If RN , BSN preferred but ASN… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... First Refusal (ROFR) requests, review of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Cardiovascular Center- CVC 5,...to deliver the safest and highest quality of health care . Applicants are expected to review the ... opportunity employer. **Job Detail** **Job Opening ID** 269110 **Working Title** REGISTERED NURSE (Cardiovascular Center- CVC 5, Adult Intermediate… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital ( PACU ) Apply Now **How to Apply** This is a "multiple-fill" job opening: A total of three (3) (1.0 FTE), Registered ... review charts for H&P, consent, etc.). Provide direct care for Pre-op patients. **Nursing Specific Info** Salary &...employer. **Job Detail** **Job Opening ID** 269126 **Working Title** REGISTERED NURSE : University Hospital ( PACU )… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse ( RN )** for a full-time position supporting the 2d Medical Group, ... review will be required.Reviews previous and present medical care practices as needed for patterns, trends, orincidents of...Utilization Management is required. Full time employment as a registered nurse within the last 36 months… more