Bachelor's degree in nursing, healthcare management, or a related field * License(s) or Certifications(s) * Proven experience in utilization management or a related field, with a deep understanding ...
Bachelor's degree in nursing, healthcare management, or a related field * License(s) or Certifications(s) * Proven experience in utilization management or a related field, with a deep understanding ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
Graduate of an accredited school of nursing. Licensure/Certification: Must be licensed to practice ... Prior experience in utilization review, case management, discharge planning, prospective payment ...
Graduate of an accredited school of nursing. Licensure/Certification: Must be licensed to practice ... Prior experience in utilization review, case management, discharge planning, prospective payment ...
Clinical Denial Analyst (RN)
Evansville, IN · On-site
$28.71 - $40.19/hr
Minimum of two (2) years performing utilization review, charge audit, case management or similar ... Registered Nurse // HRS // Healthcare Resources // UM // Utilization Management // Case Management ...
Clinical Denial Analyst (RN)
Evansville, IN · On-site
$28.71 - $40.19/hr
Minimum of two (2) years performing utilization review, charge audit, case management or similar ... Registered Nurse // HRS // Healthcare Resources // UM // Utilization Management // Case Management ...
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Life at Ascension: Where purpose meets opportunity ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Life at Ascension: Where purpose meets opportunity ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Life at Ascension: Where purpose meets opportunity ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Life at Ascension: Where purpose meets opportunity ...
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
At CVS Health ® , you'll be surrounded by passionate colleagues who care deeply, innovate with ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Registered Nurse Case Management
Evansville, IN · On-site
$84K/yr
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Registered Nurse Case Management
Evansville, IN · On-site
$84K/yr
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Two (2) or more years of hospital case management, utilization management, or care coordination experience preferred. Current ACM-RN, CCM preferred Equal employment opportunity employer Ascension ...
Registered Nurse Case Manager - Indianapolis - Sign On Bonus
Indianapolis, IN · On-site
$60.52 - $129.62/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
New
Registered Nurse Case Manager - Indianapolis - Sign On Bonus
Indianapolis, IN · On-site
$60.52 - $129.62/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ...
New
Comprehensive evidence-based nursing care ... The role integrates and coordinates utilization management, care facilitation, and discharge ...
Comprehensive evidence-based nursing care ... The role integrates and coordinates utilization management, care facilitation, and discharge ...
Functions as liaison with payer representatives to manage the rehabilitation process in keeping ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Functions as liaison with payer representatives to manage the rehabilitation process in keeping ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Functions as liaison with payer representatives to manage the rehabilitation process in keeping ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Functions as liaison with payer representatives to manage the rehabilitation process in keeping ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Nurse Practitioner Float - MC
Mooresville, IN · On-site
$82.04/hr
Training will take place during weekdays, but once completed, these positions will transition to ... Are you actively working with a CVS recruiter on a permanent role? * Are you open to occasional ...
Nurse Practitioner Float - MC
Mooresville, IN · On-site
$82.04/hr
Training will take place during weekdays, but once completed, these positions will transition to ... Are you actively working with a CVS recruiter on a permanent role? * Are you open to occasional ...
Weekday Cvs Utilization Management Nurse information
What is a Weekday CVS Utilization Management Nurse?
A Weekday CVS Utilization Management Nurse is a registered nurse who works for CVS Health, focusing on evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves reviewing patient cases, coordinating with healthcare providers, and ensuring that treatments and services meet established guidelines and insurance requirements. These nurses typically work regular weekday hours, rather than nights or weekends. They play a key role in helping patients receive appropriate care while also managing healthcare costs for the organization.
What are the key skills and qualifications needed to thrive as a Weekday CVS Utilization Management Nurse?
To thrive as a Weekday CVS Utilization Management Nurse, you need a valid RN license, strong clinical assessment skills, and experience in case management or utilization review. Familiarity with healthcare management software, insurance guidelines, and medical coding systems such as ICD-10 is typically required. Exceptional critical thinking, attention to detail, and effective communication help nurses advocate for appropriate patient care while collaborating with providers and payers. These skills ensure proper resource utilization, regulatory compliance, and optimal patient outcomes in a managed care setting.
How does a Weekday CVS Utilization Management Nurse typically collaborate with physicians and case managers?
As a Weekday CVS Utilization Management Nurse, you will regularly interact with physicians and case managers to review patient care plans and ensure appropriate resource utilization. This role involves evaluating medical records, discussing treatment options, and providing clinical recommendations to support cost-effective, quality care. Effective communication and teamwork are essential, as you’ll serve as a bridge between clinical staff, patients, and administrative teams to coordinate authorizations and resolve coverage questions.
What is the difference between Weekday Cvs Utilization Management Nurse vs Weekend Cvs Utilization Management Nurse?
| Aspect | Weekday Cvs Utilization Management Nurse | Weekend Cvs Utilization Management Nurse |
|---|---|---|
| Work Schedule | Monday to Friday, standard business hours | Weekend shifts, typically Saturday and Sunday |
| Certifications | RN license, utilization review certification often preferred | RN license, utilization review certification often preferred |
| Work Environment | Office-based, healthcare setting, insurance company | Office-based, healthcare setting, insurance company |
| Job Responsibilities | Review medical necessity, authorize services, coordinate care | Review medical necessity, authorize services, coordinate care |
The main difference between Weekday Cvs Utilization Management Nurse and Weekend Cvs Utilization Management Nurse lies in their work schedule. Both roles require similar certifications, responsibilities, and work environments, but the weekday nurse works during standard business hours, while the weekend nurse covers weekend shifts. Both positions are essential for continuous patient care and insurance operations.
What are the most commonly searched types of Cvs Utilization Management Nurse jobs in Indiana?
The most popular types of Cvs Utilization Management Nurse jobs in Indiana are:
What cities in Indiana are hiring for Weekday Cvs Utilization Management Nurse jobs?
Cities in Indiana with the most Weekday Cvs Utilization Management Nurse job openings:
Job description
- JOB SUMMARY AND SPECIFICATIONS
- JOB SUMMARY
- Responsible for reviewing and evaluating the medical record for necessity and appropriateness of healthcare services and treatments before, during and after care. Collaborating with healthcare providers, clinical staff, case managers, insurance companies, clinical coders and patient access staff to ensure the patients are receiving the right level of care per industry standards.Â
- MINIMUM QUALIFICATIONS
- Professional & Technical Skills
- Several years of experience in a clinical settingExperience with healthcare information systems and software
- Education
- Bachelor's degree in nursing, healthcare management, or a related fieldÂ
- License(s) or Certifications(s)
- Proven experience in utilization management or a related field, with a deep understanding of healthcare delivery systems and payment models. Strong knowledge of medical terminology, diagnostic and procedural coding, and reimbursement methodologies. Excellent analytical and problem-solving skills, with the ability to interpret complex healthcare data and identify trends and patterns. Experience in communication with the ability to liaise effectively with diverse stakeholders, including medical staff, insurance providers, and regulatory agencies. Proficient computer skills, including experience with electronic health record systems and utilization management software. Strong attention to detail and ability to adhere to strict confidentiality guidelines. Sound knowledge of applicable laws, regulations, and accreditation standards related to utilization review. Demonstrated ability to work independently and manage multiple priorities in a fast-paced environment.
- Other Skills or Requirements
- PRN status with Integrated Case Management team. Weekend availability required. Some evenings required. Must work well with a team. Acute care and D/C planning experience preferred.
- Skilled to Care for Certain Age-Related Patient Groups (incumbents will be skilled in the care of the following patient groups)
- All age groups