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Utilization Management Nurse Consultant Jobs

Case Management - Nurse, Consultant
By Blue Shield of California At , Long Beach $109,120 - $163,680 a year
Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
Assumes supervisor day to day responsibilities in manager’s absence and under the direction of the manager
A minimum of 3+ year experience in inpatient, outpatient or managed care environment required
Health insurance/managed care experience desired.
Requires at least 7 years of prior experience in nursing, healthcare or related field
Transitions of care experience desired
Utilization Management Nurse - Pchp
By Parkland Health and Hospital System At , Dallas, 75201
Three years of experience in an acute clinical nursing or medical management setting.
Knowledge of utilization management and case management principles is preferred.
May have an equivalent combination of education and experience to substitute for the experience requirements.
Knowledge of NCQA, Federal and Texas Medicaid Utilization Management (UM) regulations.
Three years of managed care experience is preferred.
Provides appropriate consultation and referral to case management.
Utilization Management Clinical Consultant
By CVS Health At , Baton Rouge $28.25 - $60.50 an hour
3+ years clinical practice experience, e.g., hospital or behavioral health setting,
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Experience working in the Louisiana Medicaid Behavioral Health system *strongly preferred*.
Utilization review experience strongly preferred.
Licensed addiction counselor (LAC) and/or substance use disorder treatment experience preferred
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Utilization Management Clinical Consultant
By CVS Health At , $28.25 - $60.50 an hour
3+ years clinical practice experience, e.g., hospital or behavioral health setting,
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Experience working in the Louisiana Medicaid Behavioral Health system *strongly preferred*.
Utilization review experience strongly preferred.
Licensed addiction counselor (LAC) and/or substance use disorder treatment experience preferred
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Utilization Management Nurse Consultant
By CVS Health At , Arnold $28.25 - $60.50 an hour
2+ years of recent acute hospital clinical experience as an RN (recent defined as in the past 10 years).
Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
Must have an active and unrestricted RN license
Utilization Management Clinical Consultant
By CVS Health At , Galveston $28.25 - $60.50 an hour
3+ years clinical practice experience, e.g., hospital or behavioral health setting,
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Experience working in the Louisiana Medicaid Behavioral Health system *strongly preferred*.
Utilization review experience strongly preferred.
Licensed addiction counselor (LAC) and/or substance use disorder treatment experience preferred
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Utilization Management Nurse, Consultant
By Blue Shield of California At , Rancho Cordova, 95670 $109,120 - $163,680 a year
Previous experience in utilization management preferred
Working knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, Case Management Society of America CMSA)
Requires a bachelor's degree or equivalent experience
Requires at least 7 years of prior relevant experience
Strong computer skills related to Windows-based programs and applications
Strong clinical documentation skills, independent problem identification and resolution skills
Rn Utilization Management Nurse Cst Est Location Remote
By Optum At , Atlanta, 30319
Experience in utilization review and/or utilization management
Collaborate with UnitedHealthcare Medical Directors on performing utilization management
Follow all Standard Operating Procedures in end-to-end management of cases
Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
Identify delays in care or services and manage with MD
Utilization Management Nurse Consultant
By CVS Health At , $28.25 - $60.50 an hour
This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Weekend/holiday coverage will occasionally be required
Communicates with providers and other parties to facilitate care/treatment
Utilization Management Nurse Consultant
By CVS Health At , Opelousas $28.25 - $60.50 an hour
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Identifies members who may benefit from care management programs and facilitates referral
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
3+ years of clinical practice experience in an inpatient setting required
2+ years of experience as a Registered Nurse
Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
Utilization Management Nurse (Gulf South Region)
By Humana At , , Al
Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred
3-5 years of prior clinical experience preferably in an acute care hospital, skilled or rehabilitation clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Excellent communication skills both verbal and written
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Previous Medicare experience a plus
Rn Utilization Management Nurse 2 - Se Region - Remote
By Humana At , , Tx
2 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment
Home Health Utilization Management Nurse
By Humana At , , Tn
Previous experience in Case Management, Discharge Planning or Utilization Management
The Utilization Management Nurse 2/Home Health Utilization Management:
Clinical experience in Medicare Home Health (in the last 12 months)
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Previous Medicare/Medicaid Experience a plus
Utilization Management Registered Nurse
By Humana At , , Fl
Workstyle: Remote work at home
3-5 years acute care, (Medical Surgical, Heart, Lung or Critical Care), skilled or rehabilitation nursing experience
Previous hospital or health plan utilization management
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Education: BSN or Bachelor's degree in a related field
Utilization Management Nurse: Home Solutions
By Humana At , , Ky
Excellent organizational and time management skills
2 to 3 years of home health experience and/or utilization management experience
Experience in a managed care setting
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Solid analytical skills to understand and interpret data to make recommendations to improve patient care.
Collaboration skills to effectively interact with multiple parties both internal and external.
Utilization Management Nurse Jobs
By MFS Talent At Palo Alto, CA, United States
Maintain guidelines, federal and state regulations, payer requirements, and best practices related to utilization management.
Educate healthcare professionals and staff on utilization management principles, documentation requirements, and regulatory updates.
Case Management or Utilization Management certification or willingness to obtain within 2 years of hire.
Maintain accurate and thorough documentation of utilization management activities, including reviews, decisions, and interventions.
Identify opportunities for process improvement and participate in quality assurance activities related to utilization management.
Three (3) years of progressively responsible and directly related work experience, preferred.
Staff Nurse - Utilization Management - 100%
By University of Iowa At Iowa, United States
Previous experience with Utilization Management and/or Case Management is desired.
3-5 years of RN clinical nursing experience is required.
Excellent written and verbal communication skills are required.
Demonstrates excellent interpersonal skills with patients/families, nursing staff, and interdisciplinary team members as demonstrated through written and verbal interactions.
Previous experience performing Utilization Reviews in a RN capacity is recommended.
Previous experience involving high-volume public contact customer service is desired.
Utilization Management Nurse Jobs
By Campbell Healthcare Solutions At United States

The Utilization Management Nurse will use his/her professional judgment to evaluate the request and ensure that services are appropriately approved, recognize care coordination opportunities and refer ...

Nurse Clinician - Level Of Care/Utilization Management - 100%
By University of Iowa At Iowa City, IA, United States
Participate in the development and implementation of disease-specific management programs with associated educational and clinical resources to support the patient/family/staff.
Demonstrated excellence in critical thinking, organizational skills, independent decision-making, time management, prioritization, and problem-solving skills
Develops & presents educational materials to inpatient units approved by the Nurse Manager.
Demonstrated experience in providing education to multiple stakeholders.
Experience and knowledge with Medicare Guidelines of outpatient observation and 2 midnight rule is desired.
Serves as an educational and clinical resource to clinics, patients, families, staff, and the community.
Utilization Management Clinical Consultant
By CVS Health At , , Az $28.25 - $60.50 an hour
Utilization of clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Utilization of clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members
Identification of members who may benefit from care management programs and facilitation of the referral
1+ year(s) of utilization management experience within a managed care organization
Identification of opportunities to promote quality effectiveness of healthcare services and benefit utilization
5+ years of clinical experience as a Registered Nurse