- CVS Health (Richmond, VA)
- …do it all with heart, each and every day. **Position Summary** This UM Nurse Associate position is with Aetna's Long-Term Services and Supports (LTSS) team and is a ... care authorization requests and private duty nursing requests. **Required Qualifications** + Must reside in Eastern Standard Time, Preferably Virginia + LPN with… more
- Commonwealth Care Alliance (Boston, MA)
- …Bachelor's Degree in Nursing Required Experience ( must have): * 3-5 years utilization management experience * 3+ years' experience working in a health plan, ... travel to clinical practices may be required. Required Education ( must have): * Associate degree in Nursing...management experience preferred Required Knowledge, Skills & Abilities ( must have): * Expertise in managing utilization … more
- CVS Health (Tallahassee, FL)
- …state of Florida. **Applicant must reside in Florida** . As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... - Must reside in Florida **Preferred Qualifications** - Previous Utilization Management and/or Managed Care experience preferred - Discharge planning… 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: Full ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations… more
- Commonwealth Care Alliance (Boston, MA)
- …degree Required Experience ( must have): * 3+ years combined clinical and utilization management experience Desired Experience (nice to have): * 3+ years' ... procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical… more
- CVS Health (Baton Rouge, LA)
- …constituents in the coordination and administration of the utilization /benefit management function. _WFH and hybrid Colleagues must manage dependent care ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state of… more
- Commonwealth Care Alliance (Boston, MA)
- …(Certified Case Manager) **Required Experience ( must have):** + 2 to 3 years Utilization Management experience in a managed care setting + 2 or more years ... Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization ...travel to home office may be required. **Required Education ( must have):** + Associate 's degree **Desired Education… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care....and handle or feel small controls and objects. The associate must frequently talk and hear. Weights… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Humana (Charleston, WV)
- …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, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more