Utilization Management Nurse
2 months ago
Job Title: Utilization Management NurseJob DescriptionWe are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate will be responsible for meeting all State and Federal regulations, as well as internal mandates related to claims and preauthorization processing. This role involves accurate and timely medical review of claims, preauthorizations, and customer service inquiries. You will also be involved in special projects such as training new hires, provider outreach, project work, peer mentoring, new system implementation, and system testing.Responsibilities+ Ensure compliance with State and Federal regulations, as well as internal mandates for claims and preauthorization processing.+ Perform accurate and timely medical reviews of claims and preauthorizations.+ Handle customer service inquiries related to claims and preauthorizations.+ Complete special projects, including training new hires, provider outreach, project work, peer mentoring, new system implementation, and system testing.+ Determine availability of benefits according to company contracts, endorsements, and medical policy.+ Verify member eligibility prior to medical review.+ Foster constructive relationships with all departments.+ Maintain professional licensure and practice within the scope of licensure.+ Collaborate and consult with healthcare providers, members, and an internal team of clinical support specialists, nurses, physicians, medical directors, and pharmacists to ensure medically appropriate, high-quality, cost-effective care.Essential Skills+ Current, unrestricted RN license or a compact license from specified states.+ Three years of clinical experience in a healthcare setting.+ Two years of experience in medical review or utilization management.+ Knowledge of utilization review, Medicare, utilization management, and EMR systems.Additional Skills & Qualifications+ Bachelor's degree in a healthcare field (preferred).+ Certification in managed care (preferred).+ Clinical experience in multiple levels of care.+ Knowledge of accreditation standards and regulatory requirements.+ Experience with Guiding Core, InterQual, and MCG EMR systems.+ Experience in acute care, post-acute care, and outpatient care is a plus.Work EnvironmentThis is a 100% remote position. The company will provide a laptop, two monitors, a mouse, keyboard, and headset. The core shift is Monday to Friday, 7 am to 5 pm CST, but there are options for flexible shifts, including Tuesday to Saturday or Sunday to Thursday. Weekend-only part-time positions are also available.About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:+ Hiring diverse talent+ Maintaining an inclusive environment through persistent self-reflection+ Building a culture of care, engagement, and recognition with clear outcomes+ Ensuring growth opportunities for our peopleThe company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
-
Utility Equipment Electrician
4 months ago
Omaha, United States University of Nebraska Medical Center Full timePosition Summary Perform as a skilled electrician in all phases of utility equipment electrical maintenance, construction, repair, and other activities related to the trade. Position is responsible for utility electrical system compliance and electrical distribution operation for the Utility Plant that serves the UNMC/NE Med Campus Electrical...
-
Omaha, Nebraska, United States Nurse First Full timeJob OverviewNurse First is seeking a skilled travel nurse to join our team in Omaha, Nebraska. As a critical care travel nurse, you will be responsible for providing high-quality patient care in a fast-paced CVICU environment.Estimated Salary: $145,000 - $155,000 per year, based on 12 hour shifts and 36 hours per week.About the RoleThis travel nursing...
-
Omaha, Nebraska, United States Nurse First Full timeJob SummaryNurse First is seeking a skilled Registered Nurse (RN) to join our team as a travel nurse in the Progressive Care Unit. This exciting opportunity allows you to experience new locations and work environments while utilizing your expertise to provide exceptional patient care.About the JobSpecialty: PCU - Progressive Care UnitDiscipline: RNStart...
-
Travel Sonography Specialist
4 weeks ago
Omaha, Nebraska, United States Nurse First Full timeNurse First, a renowned travel agency, is seeking an experienced Echo Technologist to join their team for a 13-week assignment in Omaha. As a travel sonography specialist, you will have the opportunity to utilize your skills in a dynamic environment while exploring the city.About Nurse First: Founded by a nurse, our company is committed to providing...
-
Diagnostic Imaging Specialist
3 weeks ago
Omaha, Nebraska, United States Nurse First Full timeNurse First is a travel agency committed to providing nurses with the best experience possible. We believe in giving our travelers the freedom to focus on patient care while experiencing new places without any worries.As a Diagnostic Imaging Specialist, you will be responsible for operating imaging equipment and assisting patients during diagnostic...
-
Travel Surgical Technologist for Omaha
4 weeks ago
Omaha, Nebraska, United States Nurse First Full timeNurse First is seeking a skilled Surgical Technologist for a 13-week assignment in Omaha, Nebraska. This role offers the opportunity to work in a dynamic environment and utilize your expertise to provide exceptional patient care.About the Assignment:Duration: 13 weeksShift: 12 hours, daysHours per week: 36What We Offer:A competitive salary of $**105,000 -...
-
Labor Nurse Specialist
3 weeks ago
Omaha, Nebraska, United States Jackson Nurse Professionals Full timeAt Jackson Nurse Professionals, we're seeking a skilled Labor and Delivery travel nurse RN to join our team for a 13-week contract assignment at a state-of-the-art hospital in Omaha, Nebraska. About the Role:This is a rewarding opportunity for experienced Registered Nurses who can manage the care of mothers and their babies during the delivery process....
-
Clinical Nurse Consultant
1 week ago
Omaha, Nebraska, United States Ace Care Management Full timeWe are seeking dedicated Contract Assessment Nurses for an exciting opportunity in Georgia. With a competitive salary range of $65,000 - $85,000 per year, you will have the chance to make a real difference in the lives of those we serve.Job DescriptionAce Care Management is an Upper Case Management Company licensed by the Department of Community Health to...
-
Critical Care Nurse Opportunity in Omaha, NE
3 weeks ago
Omaha, Nebraska, United States Travel Nurse Across America Full timeWe are seeking a skilled Critical Care Nurse to join our team of travel nurses in Omaha, NE. As a Progressive Care Unit (PCU) RN, you will play a vital role in providing high-quality patient care in a fast-paced environment.The PCU is designed for patients who require close monitoring and frequent assessment, but are not unstable enough to need ICU care. In...
-
Registered Nurse
3 months ago
Omaha, United States St Croix Hospice Full timeRegistered Nurse (RN) Case Manager Job Details Level Experienced Job Location Omaha NE - Omaha, NE Education Level 2 Year Degree Job Shift Day Job Category Nurse Description TheRegistered Nurse Case Managerplans, organizes and directs hospice care and is experienced in nursing, with emphasis on community health education/experience. The...
-
Omaha, Nebraska, United States Travel Nurse Across America Full timeJob Description:We are seeking an experienced Critical Care Registered Nurse to join our team at a top-rated hospital in Omaha, NE. This is a fantastic opportunity for a travel nurse to work in a fast-paced Progressive Care Unit (PCU) environment and gain valuable experience caring for patients with complex medical needs.About the Role:As a PCU Travel Nurse,...
-
Labor and Delivery Nurse Specialist
3 weeks ago
Omaha, Nebraska, United States Jackson Nurse Professionals Full timeJob Overview:Rewarding Labor and Delivery Position for Experienced RNsJackson Nurse Professionals is seeking skilled Registered Nurses with labor and delivery experience to join their team at a state-of-the-art hospital in Omaha, Nebraska. This 13-week contract assignment offers an incredible opportunity for professionals looking to take their careers to the...
-
Critical Care Travel Nurse
3 weeks ago
Omaha, Nebraska, United States Reliable Nurse Staffing Full timeReliable Nurse Staffing is seeking a travel nurse for a critical care position in Omaha, Nebraska.About the JobThis is a 13-week assignment with a shift of 12 hours per night and 36 hours per week. The ideal candidate will have current licensure in Nebraska and must possess excellent critical care skills.ResponsibilitiesCare for critically ill patients in a...
-
Omaha, Nebraska, United States Jackson Nurse Professionals Full timeOmaha, Nebraska Travel Nursing Job:Jackson Nurse Professionals is seeking a skilled travel nurse RN for a rewarding Labor and Delivery assignment in Omaha, Nebraska.About the Assignment:This 13-week contract opportunity requires a dedicated Registered Nurse with experience managing the care of mothers and their babies during the delivery process. The...
-
PCU Nurse Wanted for Travel Contract in Omaha
4 weeks ago
Omaha, Nebraska, United States Jackson Nurse Professionals Full timeAs a renowned healthcare staffing agency, Jackson Nurse Professionals is seeking an experienced RN to fill a 13-week contract in our Progressive Care Unit. We are looking for a skilled and compassionate nurse to join our team in Omaha, Nebraska. If you have a passion for delivering high-quality patient care and a strong background in PCU nursing, we...
-
Labor and Delivery Nurse Night Shift
4 weeks ago
Omaha, United States Jackson Nurse Professionals Full timepadding-bottom:1.25rem">Jackson Nurse Professionals is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Omaha, Nebraska.Job Description & RequirementsSpecialty: Labor and DeliveryDiscipline: RNStart Date: ASAPDuration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelWe're offering a rewarding LD position for...
-
Omaha, Nebraska, United States Jackson Nurse Professionals Full timeWe are seeking a skilled Registered Nurse to join our team as a travel nurse in Omaha, Nebraska. Our company, Jackson Nurse Professionals, is dedicated to providing cost-effective staffing solutions to over 500 hospitals nationwide.Job Summary:As a travel nurse, you will have the opportunity to work in a state-of-the-art hospital in Labor and Delivery,...
-
Omaha, Nebraska, United States Travel Nurse Across America Full timeTravel Nurse Across AmericaWe are currently seeking a skilled Tele RN for an immediate travel nurse position in the vibrant city of Omaha, Nebraska. As a dedicated provider of exceptional patient care, you will join our esteemed team of healthcare professionals to deliver top-notch services.About the Role:As a Tele Travel Nurse, you will be responsible for...
-
ICU Registered Nurse Travel Position in Omaha
4 weeks ago
Omaha, Nebraska, United States Reliable Nurse Staffing Full timeJob Title: ICU Registered Nurse Travel Position in OmahaWe are seeking a skilled and experienced ICU Registered Nurse to join our team in Omaha, Nebraska.About the JobThis is a 13-week travel nursing assignment with 36 hours of work per week. The shift will be 12 hours long, taking place at night. The ideal candidate should have experience working in an ICU...
-
Travel Nurse Opportunities in Omaha
13 hours ago
Omaha, Nebraska, United States Travel Nurse Across America Full timeJob Title: Travel Nurse RNAre you a skilled and adventurous nurse looking for a new challenge? We have an exciting opportunity for a Progressive care unit RN to join our team as a travel nurse in Omaha, NE.About the Job:This assignment is located in a traveler-friendly facility that offers excellent pay, benefits, bonus opportunities, and travel...