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 - CA Licensed
A company is looking for a Utilization Management (UM) Nurse - Pre-Service with RN/LVN California licensure. ...
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...
Oncology Nurse Navigator - NY IL CA Licensed
A company is looking for an Oncology Nurse Navigator to support cancer patients through their care journey. ...
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. Ensures that t...
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...
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 Nurse Reviewer
A company is looking for a Utilization Management Nurse Reviewer for a weekend shift. ...
Utilization Management Nurse Consultant
Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and le...
Utilization Management Nurse Consultant
A company is looking for a Utilization Management Nurse Consultant. ...
Licensed Vocational Nurse - Utilization Management
A company is looking for an LVN in Utilization Management - Remote. ...