- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job ... Summary: Our Utilization Management Appeals Nurse - LPN/RN will...requirements, including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies to physician reviewers for… more
- Universal Health Services (Temecula, CA)
- …Healthcare Regional office in Temecula, CA is seeking Two (2) LVN Full-Time Central Utilization Review Nurses who will be responsible for carrying out ... correct payer source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers, external regulatory… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ID**: 34207 ... + Assist in preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review , Data Validation, CMS… more
- Humana (Richmond, VA)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management: + Review cases using clinical knowledge, communication skills, and ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to ... 2 Holiday a year. The Utilization Management Nurse 2 Front End Review uses clinical...None **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided… more
- Actalent (Sunrise, FL)
- …providing education to physicians and other team members on issues related to utilization review (UR) including appropriate admissions and placements. You will ... Utilization Management Nurse Job Description In...+ Knowledge of case management and UR concepts + Utilization review of prior authorizations for medical… more
- University of Washington (Seattle, WA)
- …. RN2, Utilization Management Specialist. ... Req #: 228720 Department: HARBORVIEW - UTILIZATION MANAGEMENT Posting Date: 05/03/2024 Closing Info: Open... Management Specialist RN2 is responsible for the ongoing review of a designated group of patients through the… more
- State of Indiana (Indianapolis, IN)
- Utilization Review Coordinator Date Posted: May...college or university. * Current licensure as a Registered Nurse (RN) in the State of Indiana. * Two ... to the treatment team. * Development of the annual utilization review plan. * Serve as the...nursing in the State of Indiana as a Registered Nurse . + Must hold and maintain a CPR certification.… more
- Centene Corporation (Phoenix, AZ)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- State of Michigan (Lansing, MI)
- Medicaid Utilization Analyst 9-P11 - BPHASA Medical Equipment and Services Section Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4533727) ... Apply Medicaid Utilization Analyst 9-P11 - BPHASA Medical Equipment and Services...and Inclusion Plan. This position functions as a clinical review professional responsible for conducting clinical reviews of applications/requests… more
- Centene Corporation (Phoenix, AZ)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... the state of Arizona** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Humana (Columbus, OH)
- …+ Supervises utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review , prior ... health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to support… more
- Centene Corporation (Tallahassee, FL)
- …**THIS POSITION IS REMOTE/WORK FROM HOME, NO TRAVEL, SUPPORTING A MARKET PLACE UTILIZATION MANAGEMENT TEAM.** **APPLICANTS MUST BE ABLE TO WORK EITHER CENTRAL TIME ... POSITION IS BONUS ELIGIBLE.** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team… more
- Bon Secours Mercy Health (Springfield, OH)
- …of Primary Function/General Purpose of Position** In the capacity of a Registered Nurse , provide and facilitate coordination of services during the acute care stay ... management team, and interdisciplinary care team members during admission for appropriate utilization of services, length of stay and safe discharge plan. Coordinate… more
- The Cigna Group (Mesa, AZ)
- **Summary** The Nurse Case Management Lead Analyst is an integral member of the Care Management department as part of Evernorth Care Group (ENCG) primary care team. ... on the management of high- and rising-risk, disease burdened members. The Nurse Case Management Lead Analyst utilizes clinical skills to assess, plan, implement,… more
- Dignity Health (Rancho Cordova, CA)
- **Overview** This position is hybrid in-office and work from home.** Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit ... to maintaining excellence in care and service. **Responsibilities** This position is hybrid in-office and work from home.** **Position Summary:** Under the guidance… more
- Commonwealth Care Alliance (Springfield, MA)
- …member needs are consistently met + Manage panel-wide and member-specific utilization trends. + Liaise with CCA and community-based PCPs/specialists + Collaborate ... planning. + MA / MI only: Reviews approved authorizations to assess appropriate utilization , based on members' needs + Actively participate in the evaluation of own… more
- CareFirst (Baltimore, MD)
- …**Knowledge, Skills and Abilities (KSAs)** + Knowledge of NCQA requirements of utilization review , Case Management standards and guidelines, appeal rights and ... Strategic Plan through direction of the Clinical Medical Claims Review , Medical Underwriting, Medical Policy, Clinical Appeals and Analysis...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Centene Corporation (Olympia, WA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Bassett Healthcare (Cooperstown, NY)
- …care to surgical patients across 12 operating rooms and one hybrid operating room, with accessible state-of-the-art equipment! Annually, we navigate approximately ... specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Operating Room / Perioperative Services unit… more