- Houston Methodist (The Woodlands, TX)
- …and eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a...coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation… more
- Commonwealth Care Alliance (Boston, MA)
- …& Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and...* Act as liaison with medical director, provider relations, case management and quality teams to support… more
- Houston Methodist (Sugar Land, TX)
- …and eligibility for state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance improvement, and ... national and local coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan of… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Humana (Charleston, WV)
- …Qualifications** + Bachelor's degree in nursing (BSN) + Previous experience in discharge planning, utilization management or case management a plus + ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...work may be required on a rotational basis; some travel to home office may be required. **Required Education… more
- Florida Health Care Plans, Inc. (Daytona Beach, FL)
- … within the community to various locations. POSITION SUMMARY: As part of the Utilization Management division, the social worker will intervene with members who ... order to fully engage with members and their families, travel to hospitals, rehab or skilled nursing facilities and...relationships with FHCP colleagues and external vendors in providing case management services is essential to the… more
- CVS Health (Boise, ID)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... anywhere in the US. **Schedule is Monday - Friday 8am-5pm est.** No travel required. Non-exempt. Hourly. Pay: Bi-weekly. No shift premium. Occasional Overtime may be… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- … review and/or quality assurance programs; + Conducts various types of case reviews for quality and appropriate medical management , cost containment, ... Utilization Review Nurse (40 Hour) Office/On-Site Recruitment #...+ Incumbents in this class may be required to travel . Conclusion AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER The State… more
- Guthrie (Troy, PA)
- …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... , utilization review, and payer knowledge. A Case Management certification or obtaining a ...as necessary in the performance of this position. + Travel for this position is sometimes required. + Participation… more
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