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 - 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 Consultant
This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state. 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 op...
Utilization Management Nurse
A company is looking for a Utilization Management Nurse (MLTC Focus) to perform clinical reviews for Managed Long-Term Care members. ...
Utilization Management Nurse Reviewer
A company is looking for a Utilization Management Nurse Reviewer for a weekend shift. ...
Travel Nurse - RN - Case Manager - $2127.72 / Week - Hiring Now
TRS Healthcare is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in Toledo, OH. TRS Healthcare is seeking a Registered Nurse that is licensed in OH to work in the specialty area of Case Management. Current RN license within the state of practice. Up to $1,00...
Travel Nurse RN - Case Manager, Acute Care Case Management - $1,962 per week
Review Skills: Care coordination, Discharge Planning, Needs Assessment/ Order DME, Prior Authorizations • Care Navigation/ Discharge Planning • Charge Experience – preferred • Teaching Hospital Experience – preferred • Community Hospital Experience – preferred &...
Travel Registered Nurse - Case Manager - $1,966 per week in Toledo, OH
Purpose of the Position:Responsible for the delivery of direct patient care using the nursing process and as defined by the healthcare facility in their unit specific job description.Requirements:-Graduate of an RN program-Previous work experience as an RN-Current unrestricted RN license in the stat...
Travel Nurse RN - Case Manager - $2,096 per week in Toledo, OH
TravelNurseSource is working with Lead Health to find a qualified Case Manager RN in Toledo, Ohio, 43606!. 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 Tole...
Case Manager RN
Details of the Case Manager RN opening:. Daily Range of Responsibilities of the Case Manager RN:. Qualifications for the Case Manager RN:. Certified Case Manager (CCM) preferred. ...
RN Case Manager - Weekend - Day Shift - Relocate to Delaware
The RN Case Manager will be responsible for managing patient care and drive patient progression and establish a discharge plan. RN Care Manager - manage patient care and drive patient progression and establish a discharge plan. RN with experience in Case Management, Transitional Care, or Discharge P...