A company is looking for a Utilization Management (UM) Nurse - Pre-Service with RN / LVN California licensure.Key ResponsibilitiesReview pre-certification requests for medical necessity and collaborate with medical directorsUtilize CMS and Milliman guidelines to assist in referral determinationsVerify eligibility and benefit coverage for requested services and maintain documentationRequired Qualifications, Training, and EducationCurrent, active, and unrestricted RN or LVN California licensure requiredMinimum Associate's degree (Bachelor's degree preferred)Minimum 1 year of experience with Medicaid and / or Medicare requiredKnowledge of Medicare Managed Care Plans and CMS guidelines requiredExperience with the application of UM / clinical criteria (e.
g., Milliman, InterQual) required
Utilization Management Nurse - TX Licensed
A company is looking for a Utilization Management Review Nurse who will work remotely from Texas. ...
Utilization Management Nurse - Remote
Position in this function is responsible for ensuring the integrity of the adverse determination processes and accuracy of clinical decision making, as it relates to the application of criteria and application of defined levels of hierarchy and composition of compliant denial notices. We're going be...
Pre-Admission Utilization Management Nurse
A company is looking for a Pre-Admission Utilization Management Nurse. ...
Utilization Management Nurse
As a member of the Clinical Services team, our Utilization Management Nurses provide utilization management (such as prospective concurrent and retrospective review) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for ser...
Inpatient Review Nurse - CA Licensed
A company is looking for an Inpatient Review Nurse (RN/LVN) with California licensure to join their utilization management team. ...
California Licensed Utilization Management RN
A company is looking for an RN, Utilization Management - Remote. ...
Telephonic Nurse Care Manager - CA Licensed
Key Responsibilities:Collaborate with patients and their care teams to develop and implement nursing care plansConduct assessments and evaluate biometric data to enhance clinical outcomesEngage patients in their care using Motivational Interviewing techniques to promote adherenceRequired Qualificati...
Utilization Management Nurse Reviewer
A company is looking for a Utilization Management Nurse Reviewer for a weekend shift. ...
Utilization Management Nurse
A company is looking for a Utilization Management Nurse for the Midwest Region. ...
Utilization Review Clinician - CA Licensed
A company is looking for a Utilization Review Clinician - ABA to perform reviews of member care and health status related to Applied Behavioral Analysis services. ...