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 - CA Licensed
A company is looking for a Utilization Management (UM) Nurse - Pre-Service with RN/LVN California licensure. ...
Utilization Management Nurse - TX Licensed
A company is looking for a Utilization Management Review Nurse who will work remotely from Texas. ...
Utilization Management Nurse
A company is looking for a Utilization Management Nurse (MLTC Focus) to perform clinical reviews for Managed Long-Term Care members. ...
Licensed Practical Nurse (LPN)
Licensed Practical Nurse (LPN). Must hold and maintain a current license to practice as a Licensed Practical Nurse (LPN). Licensed nursing staff are required to obtain their CPR certification within 90 days of hire. ...
RN Case Manager (Hospice)
The RN Case Manager provides intermittent skilled nursing services; communicates the patient’s progress with other disciplines and directs, supervises and instructs hospice aide staff in the provision of personal care to the patient. As a RN Case Manager you will:. ...
LPN (Licensed Practical Nurse/LVN) - Osceola, IN
LPN (Licensed Practical Nurse/LVN). Licensed Practical Nurse (LPN). Licensed Practical Nursing/Vocational Nursing certification in good standing for the relevant state location of the job. ...
LPN - Licensed Practical Nurse (Sign-On Bonus: 2,500)
Adecco Healthcare is searching for a .This is a direct-hire, full-time, and permanent opportunity.Center Hours (shifts will vary):.You will assess donor eligibility, which includes managing informed consent, providing AIDS education and confidential self-exclusion, conducting medical history intervi...
Licensed Practical Nurse - Full Time - Weekends
Supervises and evaluates care given by non-licensed team members. ...
RN - Registered Nurse
Trilogy is a great place for Registered Nurses. Hold a Registered Nurse (RN) degree or diploma from an accredited college/university. ...
Registered Nurse - Medical Surgical Unit
Registered Nurse - Medical Surgical Unit. Corewell Health is seeking a compassionate and dedicated Registered Nurse to join our medical surgical unit team at Lakeland Hospital St Joseph. ...