- CVS Health (Little Rock, AR)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team . **Position Summary** The ... a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective...projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance… more
- CVS Health (Little Rock, AR)
- …compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical policies & ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
- CVS Health (Little Rock, AR)
- …years of MS office suite experience. **Preferred Qualifications** + Experience with multiple clinical systems. + Utilization Management experience. + Ability ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
- BrightSpring Health Services (Louisville, KY)
- Our Company PharMerica Overview The Clinical Utilization Management Pharmacistis responsible for providing data driven consultative services to clients that ... enhance patient outcomes. The pharmacist works closely with Billing, Clinical Operations, Account Management and Sales to...to identify analytical requirements + In collaboration with the Clinical Services team and the Client Reporting… more
- CommonSpirit Health (Phoenix, AZ)
- …the senior leadership team , the System Vice President of Utilization management will contribute to high-level organizational decision-making, working closely ... with other executives and clinical leaders to align utilization ...UM effectiveness, and provide guidance and mentoring to UM team members, including physicians, clinical staff, and… more
- Centene Corporation (Atlanta, GA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team . + Monitors and tracks UM resources to ... ensure adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member… more
- Tufts Medicine (Burlington, MA)
- … review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization ... of Science in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Management (UM) will manage the Utilization Management team consisting of Clinicians and Non- Clinical support staff from Intake through Appeals ... with time sensitive requirements. + Support and grow the utilization management team through strong...to ensure optimal partnerships and integration with our Case Management and Clinical Program teams. + Extensive… more
- Molina Healthcare (NM)
- …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... and monitoring clinical and non- clinical team activities to facilitate integrated, proactive utilization ... team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and… more
- CVS Health (Austin, TX)
- …need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical...an RN with preference for medical-surgical and ICU experience ( team is not accepting applicants whose only acute care… more
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