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. ...
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 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...
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...
Travel Case Management (Utilization Review) RN (Registered Nurse) in Springfield, MO - 771540
A traveler facility in Springfield, MO is seeking its next amazing RN (Registered Nurse) to work in Case Management (Utilization Review). Travelers say they love to work with Medical Solutions because we offer a true partnership. Whether you’re seeking a travel healthcare contract far or near,...
Utilization Management Nurse
A company is looking for a Utilization Management Nurse for the Midwest Region. ...
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. ...
Family Nurse Practitioner - CA FL TX Licensed
A company is looking for a Nurse Practitioner for weekend telemedicine work from home. ...
Utilization Management RN - WV Licensed
A company is looking for a Utilization Management RN to collaborate with the Medical Director in driving care variance reduction and timely discharges. ...