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. ...
Licensed Practical Nurse (LPN) - Pain Management
Missouri Nurse Practice Act requiring all nursing care shall be given under the direction of a person licensed by a state regulatory board to prescribe medications and treatments or under the direction of a registered professional nurse, physician, or nurse practitioner. Licensed Practical Nurse - P...
Utilization Management Nurse - LPN
A company is looking for a Utilization Management Nurse - LPN/LVN to perform utilization reviews and appeals in a managed care payor environment. ...
NON-COMPACT STATE - PT Remote CCM/RTM Care Management Nurse (CA)
The position of the Nurse Chronic Care Coordinator, Remote will perform telephonic encounters with patients on behalf of our partners each month and develops detailed care plans within our care plan templates in the electronic health record. A minimum of two (2) years of clinical experience in a Med...
Utilization Management Supervisor - CA
A company is looking for a Supervisor, Utilization Management to oversee clinical and administrative activities for UM Prior Authorization staff. ...
Family Nurse Practitioner - CA FL TX Licensed
A company is looking for a Nurse Practitioner for weekend telemedicine work from home. ...
California Licensed Utilization Management RN
A company is looking for an RN, Utilization Management - Remote. ...
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. ...
Pre-Admission Utilization Management Nurse
A company is looking for a Pre-Admission Utilization Management Nurse. ...
Utilization Management Nurse
A company is looking for a Utilization Management Nurse for the Midwest Region. ...