- The Cigna Group (Denver, CO)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical ...case management cases for Cigna. + Uses clinical knowledge to assess inpatient admission level of care,… more
- McLaren Health Care (Port Huron, MI)
- …activities 12. Performs other duties as assigned. _Required_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from accredited ... needs in EMR for continued communication with ICM UM RN and Care Management staff 7. Assesses..._Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management / clinical … more
- Molina Healthcare (Columbus, OH)
- …+ Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management ... For this position we are seeking a ( RN ) Registered Nurse who...years of experience in case management , disease management or utilization management in… more
- WellSpan Health (York, PA)
- Utilization Management Nurse ( RN ) -...Relevant experience. Required + Experience in utilization management , case management , or clinical ... quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible...administration or management . Preferred Licenses: + Licensed Registered Nurse Upon Hire Required or +… more
- Beth Israel Lahey Health (Burlington, MA)
- …and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent clinical or utilization ... in applying the principles, methods, materials, and equipment necessary in providing utilization management services. Demonstrates clinical expertise to… more
- Beth Israel Lahey Health (Burlington, MA)
- …and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent clinical or utilization ... in applying the principles, methods, materials, and equipment necessary in providing utilization management services. + Demonstrates clinical expertise to… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management / clinical /or combination; 2 of ... clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Veterans Affairs, Veterans Health Administration (Dallas, TX)
- …responsibilities. Possess intimate knowledge of Change Healthcare InterQual review criteria, utilization management processes and principles, clinical ... and program goals. You will work in collaboration with clinical and administrative staff that are engaged in access...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Tenet Healthcare (Detroit, MI)
- …underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements ... for case management scope of services including: Utilization Management supporting medical necessity and denial... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- CVS Health (Harrisburg, PA)
- …needs and Holiday rotation required** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... convenient and affordable. Requisition Job Description **Position Summary:** **This Utilization Management (UM) Nurse Consultant...state of residence. + 3+ years of acute hospital clinical experience as an RN with preference… more