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 - LPN
A company is looking for a Utilization Management Nurse - LPN/LVN to perform utilization reviews and appeals in a managed care payor environment. ...
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...
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. ...
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 Consultant
A company is looking for a Utilization Management Nurse Consultant. ...
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...
Oncology Nurse Navigator - NY IL CA Licensed
A company is looking for an Oncology Nurse Navigator to support cancer patients through their care journey. ...
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. ...
Utilization Management Supervisor - CA
A company is looking for a Supervisor, Utilization Management to oversee clinical and administrative activities for UM Prior Authorization staff. ...