A company is looking for a Utilization Management Nurse - LPN / LVN to perform utilization reviews and appeals in a managed care payor environment.
Key ResponsibilitiesPerform pre-service and post-service UM authorization reviews based on medical necessity criteriaCommunicate outcomes of UM authorization reviews and process administrative and clinical appealsMaintain compliance with accrediting agency standards such as NCQA and CMSRequired QualificationsActive, Licensed Vocational Nurse or Licensed Practical Nurse licenseMinimum of 3 years of nursing experience in an acute or outpatient settingMinimum of 2 years of utilization management experience in a managed care payor environmentExperience with Medical Necessity Criteria including InterQual and CMS guidelinesExperience with UM authorizations and appeals for DMEPOS is highly desirable
Utilization Management Nurse Consultant
A company is looking for a Utilization Management Nurse Consultant. ...
Utilization Management Nurse - Remote
For those who want to invent the future of health care, here's your opportunity.We're going beyond basic care to health programs integrated across the entire continuum of care.Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience...
Utilization Management Nurse - TX Licensed
A company is looking for a Utilization Management Review Nurse who will work remotely from Texas. ...
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...
Utilization Management Nurse Reviewer
A company is looking for a Utilization Management Nurse Reviewer for a weekend shift. ...
Utilization Management Nurse - Remote
Performs all functions of the UM nurse reviewer. Ensures the UM nurse reviewer has provided the appropriate reference for benefits, guidelines, criteria or protocols based on the type of denial. Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting p...
Locum Certified Registered Nurse Anesthetist (CRNA) in Oregon
Ever wanted to visit Oregon? Now you can with this locum tenens opportunity! Our client is looking for a CRNA to begin coverage in early November.Hours include 8 hour shifts with some occasional night call coverage.The selected locum will be handling ANE for general/orthopedic surgery cases.There is...
Travel Nurse RN - Case Manager - $2,507 per week in Portland, OR
TravelNurseSource is working with Lead Health to find a qualified Case Manager RN in Portland, Oregon, 97225!. Travel Nurse, Traveler, Contract Nurse - whatever you like to be called, Lead has the perfect position for you! We are looking for a Case Management Registered Nurse (RN) for our client in ...
Licensed Practical Nurse (LPN)
The Licensed Practical Nurse (LPN) plays a vital role in patient care by contributing to the nursing process of assessment, planning, implementation, and evaluation. Have and maintain current licensure as a Licensed Practical/Licensed Vocational Nurse within the state of employment. We offer ongoing...
RN, Nurse Home Care Case Manager - Part Time
In 2007, Caring for Family of Companies began its journey to provide exceptional in-home care to aging adults and those with disabilities. Learn more about how we’re raising the bar in new ways at:. Current Registered Nurse (RN) license in the state of Oregon. ...