- Actalent (Orlando, FL)
- Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall health, ... and setting of care. Essential Skills + Proficiency in utilization management and utilization review ...Texas nursing license. Work Environment This is a fully remote position with working hours from 10 am to… more
- CVS Health (Salt Lake City, UT)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... And we do it all with heart, each and every day. This position will be remote working from home anywhere in the US. **Schedule is Monday - Friday 8am-5pm est.** No… more
- CVS Health (Hartford, CT)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply ... may vary based on business needs) **Location** : 100% Remote (US only) **Position Summary** American Health Holding, Inc....experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- CVS Health (Hartford, CT)
- …do it all with heart, each and every day. **Position Summary** Fully remote role in the USA. **Requires Monday-Frida** y: 11:30am-8:00pm EST shift; 8:30am-5:00pm ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- AmeriHealth Caritas (LA)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +...ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Current driver's license required… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... team. This is a great opportunity for a local remote position. **Schedule** PRN (As needed) + Shifts will...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… more
- CVS Health (Charleston, WV)
- …all with heart, each and every day. **Position Summary** This is a **fully remote position** open to applicants residing in the **Eastern Standard Time Zone** . ... , **evidence-based clinical criteria** , and **clinical practice guidelines** to review and authorize services requiring precertification. Most of the work is… more
- Adecco US, Inc. (Minneapolis, MN)
- …under the direct supervision of an RN or MD. . Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews ... $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for...turn around times. . Reviews, documents, and communicates all utilization review activities and outcomes including, but… more