- Humana (Tallahassee, FL)
- …to HCA St. Lucie Medical Center, in Palm Beach County, from home base. The Utilization Management Nurse 2 is an Onsite Nurse located at HCA St. Lucie ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes...to Member + Follows established guidelines/procedures This is an Onsite / Hybrid position at HCA St. Lucie Medical… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review, and collaborates with … more
- Huron Consulting Group (Chicago, IL)
- …the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing ... of the Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines,… more
- US Tech Solutions (Columbia, SC)
- **Duration: 3+** Months (Possible contract to hire) **Job Description:** + Onsite training - will last up to six weeks but could be extended. + A typical day would ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to… more
- Actalent (Atlanta, GA)
- …PM (Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In this role, ... Job Title: Utilization Review RN - Critical Care Location: Buckhead,...and benefits as needed. + Identify patients for case management programs. + Participate in quality improvement initiatives. +… more
- UNC Health Care (Smithfield, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- UNC Health Care (Chapel Hill, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- Elevance Health (Los Angeles, CA)
- ** Utilization Management Representative II** A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health ... through Friday 8:30 AM to 5 PM Pacific The ** Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Winston Salem, NC)
- ** Utilization Management Representative I** **Location:** Virtual, this role enables associates to work virtually full-time, with the exception of required ... an accommodation is granted as required by law The ** Utilization Management Representative I** is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Elevance Health (Winston Salem, NC)
- **Title: Utilization Management Representative I** **Location:** **Winston Salem, North Carolina or Durham, North Carolina** **Virtual:** This role enables ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more