- CVS Health (Frankfort, KY)
- …and every day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a work from home anywhere in ... external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical...Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse ( RN ) with active… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization Management ... + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- The Cigna Group (Bloomfield, CT)
- …Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse ( RN ) license in state or territory of the ... to develop models and procedures, and monitor trends, within Nurse Case Management . RN and...Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... opportunities. All Levels: + Associates degree and active NYS RN license required. Bachelors degree preferred. + Minimum of...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … 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
- Veterans Affairs, Veterans Health Administration (Salisbury, NC)
- Summary The Registered Nurse ( Utilization Management ) is aligned within the Office of Quality & Patient Safety and is responsible for providing the ... and leadership for the implementation of the medical center's Utilization Management program. Responsibilities The Registered Nurse ( Utilization … more
- AmeriHealth Caritas (Newtown Square, PA)
- …us at www.amerihealthcaritas.com. **Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates ... benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management...Bachelor's Degree in Nursing (BSN) preferred. + An active Registered Nurse ( RN ) license in… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… 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
- Premera Blue Cross (Mountlake Terrace, WA)
- …development and writing of medical policies, working closely with utilization management (UM) to promote usability. The MP Clinical Specialist monitors and ... Medicaid Services (CMS) and other sources. + Liaise with Utilization Management and Clinical Appeals... Registered Nurse , Physician's Assistant, or Nurse Practitioner with five (5) years' clinical … more