- Excellus BlueCross BlueShield (Rochester, NY)
- …(ie UM and CM). Incumbent is required to know multiple functional areas and supporting systems . + Expert in Utilization Management and ability to handle ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- UNC Health Care (Morrisville, NC)
- …health and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system , including a… more
- Alameda Health System (Oakland, CA)
- …Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... Director, Utilization Management + Oakland, CA +...background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- AmeriHealth Caritas (Lafayette, LA)
- …in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse ( RN ) license in Louisiana or multi state license ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for...managed care organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Other duties as assigned. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ) + Bachelor's degree in nursing, (or ... About The Role The Manager, Utilization Management (UM) will manage the...for UM team members including Nurses and Coordinators on systems , departmental processes, and policies. + Facilitate ongoing quality… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Humana (Little Rock, AR)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- CVS Health (Pierre, SD)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... working within the mental health system . + Previous experience with utilization management . + Ability to collaborate with various internal departments. +… more
- Cleveland Clinic (Cleveland, OH)
- …+ Graduate of an accredited School of Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through the ... most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM...Three years of equivalent full-time clinical experience as a Registered Nurse + Analytical ability required to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is...and verbal communication skills. + Proficient with multiple IT systems . + Able to identify and set goals, follow… more