- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Centene Corporation (Olympia, WA)
- …care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review , and retrospective ... + Prior Authorization highly preferred + Medicaid experience highly preferred **License/Certification:** + RN - Registered Nurse - State Licensure and/or… more
- Centene Corporation (Phoenix, AZ)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... remote position.** **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… more
- Humana (Louisville, KY)
- …**Use your skills to make an impact** **Required Qualifications** + Unrestricted licensed Registered Nurse ( RN ) or Master's level clinician with independent ... our caring community and help us put health first** The Associate Director, Utilization Management utilizes clinical nursing skills to support the coordination,… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Humana (Frankfort, KY)
- …experience working in Utilization Management processing clinical authorizations + Licensed Registered Nurse ( RN ) in the state of Kentucky (or compact ... community and help us put health first** The Manager, Behavioral Health Utilization Management uses clinical knowledge, communication skills, and independent… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... in a direct patient care clinical setting. Must have utilization management , utilization review...full, active, and unrestricted license to practice as a Registered Nurse as required in the TO… 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 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more