- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management - Oversees clinical decision review for...reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Alameda Health System (San Leandro, CA)
- …3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required Licenses/Certifications: Active ... Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS**...licensure as a Registered Nurse in the State of California,… more
- Katmai (Fort Carson, CO)
- …all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. ... **Job Requirements:** **MINIMUM QUALIFICATIONS** + Associates Degree of Nursing. Registered nurse shall be a graduate from...+ Shall possess a current, active, full and unrestricted Registered Nurses ( RN ) licensed in Colorado or… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years...+ Three (3) years of clinical experience (REQUIRED) + Utilization Management experience + Experience working in… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by...Three (3) years of clinical experience ( **Required)** + Utilization Management experience (Preferred) + Experience working… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... Knowledge, Skills, Abilities & Language (nice to have):** + Familiarity with care management and utilization management systems and workflows for populations… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Health Educator** supporting **Naval Medical Center San Diego, CA ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- Luke Staffing (Glendale, CO)
- …- Friday, 7:30 AM - 5:30 PM (excluding federal holidays) **POSITION OVERVIEW:** The Registered Nurse ( RN ) will provide on-site professional nursing services ... ** REGISTERED NURSE ** **SITE OF SERVICE:** Department...of Veterans Affairs' Eastern Colorado Healthcare System (ECHCS). The RN will serve in the Office of Community Care… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
