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 - TX Licensed
A company is looking for a Utilization Management Review Nurse who will work remotely from Texas. ...
Licensed Psychiatric Clinician (LCSW, LMFT, LPC, LADC) - Utilization Management
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. As part of Hartford HealthCare we create a better future for healthcare in Connecticut and beyond. By embodying these values we have become nationally respected for patient care and ...
Pre-Admission Utilization Management Nurse
A company is looking for a Pre-Admission Utilization Management Nurse. ...
Licensed Practical Nurse (LPN) -Pain Management
Hartford HealthCare Medical Group is one of the largest medical practices in New England with multiple locations throughout Connecticut and Rhode Island. Our physician led medical group enjoys an excellent reputation with patients and the medical community, offering primary care, urgent care and mor...
California Licensed Utilization Management RN
A company is looking for an RN, Utilization Management - Remote. ...
Licensed Psychiatric Clinician (LCSW, LMFT, LPC, LADC) - Utilization Management
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. As part of Hartford HealthCare we create a better future for healthcare in Connecticut and beyond. By embodying these values we have become nationally respected for patient care and ...
Utilization Management Nurse Consultant
A company is looking for a Utilization Management Nurse Consultant. ...
Utilization Management Nurse Consultant
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, co...
Oncology Nurse Navigator - NY IL CA Licensed
A company is looking for an Oncology Nurse Navigator to support cancer patients through their care journey. ...
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...