- Elevance Health (Latham, NY)
- …Knowledge of health insurance/benefits, medical management process, care management, and utilization review management strongly preferred. For candidates working ... ** Telephonic NICU Nurse Case Manager II**...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + NICU… more
- Elevance Health (Atlanta, GA)
- ** Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager II** is responsible for care management within the… more
- ICW Group (Lisle, IL)
- …assessment and evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical ... regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… more
- Humana (Hallandale Beach, FL)
- …ensure interaction between the company and members are optimized. The Telephonic Behavioral Health Care Manager Internship provides transitioning service members ... requirements to achieve and/or maintain optimal wellness state in a remote telephonic environment. The Behavioral Health Care Manager guides members and/or families… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- AdventHealth (Altamonte Springs, FL)
- …or medical necessity by securing Independent Medical Examinations or submitting formal Utilization Review with clinical director and claims adjuster approval and ... **Location:** Remote **The role you'll contribute:** A Workers Comp Support Registered Nurse is responsible for providing telephonic medical case management for… more
- Sharecare (Columbia, SC)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and objectives of the… more
- Option Care Health (Austin, TX)
- … telephonic nursing support and management. + Provide excellent communication to nurse colleagues regarding patients on service with review of current status, ... best and brightest talent in healthcare. **Job Description Summary:** Responsible for telephonic management of patients at the telephonic center. **Job… more
- CVS Health (Richmond, VA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Nashville, TN)
- …with transferring patients to lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation preferred - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Baystate Health (Springfield, MA)
- **RN, ACO Nurse Care Manager, Community Health Center** The **ACO Nurse Care Manager i** s responsible for the management of care for a defined group of patients ... face visits, home visits if necessary, as well as telephonic interactions. In addition, they will assist with advance...room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: 1190 ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more
- NJM Insurance (Trenton, NJ)
- …Workers' Compensation line of business by performing prospective and retrospective Utilization Review of pharmaceutical/medication requests in accordance with ... and causally related. + Evaluate requests that are routed for clinical review based upon established criteria to issue appropriate and timely determinations on… more
- CVS Health (Charleston, WV)
- …and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. What you will ... do: + Responsible for telephonic and/or face to face assessment, planning, implementing and...+ Through the use of clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends… more
- Cardinal Health (Casper, WY)
- …safe and effective transitions of care across settings, reducing avoidable hospital utilization , and promoting chronic disease management. The nurse collaborates ... and external customers. The Value-Based Care / Transition of Care Registered Nurse plays a critical role in enhancing patient outcomes and supporting healthcare… more
- Albany Medical Center (Albany, NY)
- …the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN), the RN may provide ... direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's...or APP and documents results in EHR + Performs review and triage of incoming test results, patient requests… more
- CVS Health (Franklin, KY)
- …+ Discharge Planning Experience + Motivational Interviewing skills + Managed Care/ Utilization Review Experience + Clinical experience and demonstrated knowledge ... do it all with heart, each and every day. **Position Summary** The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- CVS Health (Tallahassee, FL)
- …to their next care setting. **Position Responsibilities:** . Responsible for telephonic and/or face to face assessing, planning, implementing, and coordinating all ... overall wellness through integration. . Using clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends an… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more