- CVS Health (Columbus, OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... Summary** The Appeals Nurse Consultant plays a key role...multistate/compact licensure privileges. **Preferred Qualifications** + 1+ year(s) of Appeals experience in Utilization Management .… more
- McLaren Health Care (Grand Blanc, MI)
- …maintenance of continuing education requirements _Preferred:_ + Experience in utilization management /case management /clinical documentation. + Certification ... commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and… more
- Evolent (Montpelier, VT)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- Cognizant (Phoenix, AZ)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- Centene Corporation (New York, NY)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- McLaren Health Care (Mount Clemens, MI)
- …education sessions to maintain competency and knowledge of regulations in denials, utilization management , care management , clinical documentation, and ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Catholic Health (Buffalo, NY)
- …(the payers) and internal stakeholders including, but not limited to, Utilization Review, Case Management , Clinical Documentation Integrity, Health Information ... (CPMA), Certified Case Manager (CCM) or any other certification approved by management + Certification in a Nationally Recognized Utilization Review Criteria… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management , and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum ... members of the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care reimbursement. Working… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
Recent Searches
- Senior Sales Director Software (Nebraska)
- Seasonal TSS DCs (Colorado)
- Study Start Manager (United States)
- Systems Engineer MBSE Mid (Colorado)
Recent Jobs
-
OBGYN Hospitalist
- Geisinger (Lewistown, PA)
-
Diesel Mechanic Technician
- Ryder System (Kapolei, HI)
-
Outpatient Clinical Rehabilitation Medicine Physician (Long Covid Clinic) Specialist /NTT
- UT Health San Antonio (San Antonio, TX)
-
Specialist, Quality Assurance Shop Floor, Cell Therapy in
- Bristol Myers Squibb (Devens, MA)