- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- CVS Health (Indianapolis, IN)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in central zones.… more
- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require...one, (1), year of experience auditing and/or performing case management or utilization management chart… more
- CVS Health (Indianapolis, IN)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Baylor Scott & White Health (Indianapolis, IN)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Evolent (Indianapolis, IN)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Humana (Indianapolis, IN)
- …part of our caring community and help us put health first** The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to ... medical services and/or benefit administration determinations. The Associate Director, Utilization Management Nursing requires a...of clinical experience + 2 or more years of management experience + Licensed Registered Nurse (RN)… more
- Humana (Indianapolis, IN)
- …+ Bachelor's or Master's degree in Nursing + Prior/current experience in Utilization Management / Utilization Review with MCG + Direct or Indirect Military ... Registered Nurse (RN) + Minimum of Associate's degree in Nursing + 2 years case management experience + An active designation as a Certified Care Manager… more
- CVS Health (Indianapolis, IN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Indianapolis, IN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Veterans Affairs, Veterans Health Administration (Indianapolis, IN)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... Follows Service Agreements and Triage Tools to guide consult management . - Collaborates with appropriate provider for plan of...requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse… more
- Elevance Health (Indianapolis, IN)
- …required. **Preferred Skills, Capabilities and Experiences:** + Experience with Inpatient care management and utilization management highly preferred. + ... Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plansand providing clinical nursing support to develop,… more
- Elevance Health (Indianapolis, IN)
- …management plan and modifies as necessary. + Assists with development of utilization /care management policies and procedures. + Participates in or leads ... services in multiple states. + AS or BS in nursing preferred. Certification as a Case Manager is preferred....management experience and minimum of 1 year in Nurse Care Mgr II role or equivalent experience; or… more
- Ascension Health (Indianapolis, IN)
- …/ Certification / Registration: + One or more of the following required: + Registered Nurse credentialed from the Indiana Board of Nursing obtained prior to hire ... + Strong understanding of: + Discharge planning + Medicare/Medicaid regulations + Utilization review and management + Behavioral health and social determinants… more
- Elevance Health (Indianapolis, IN)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Veterans Affairs, Veterans Health Administration (Indianapolis, IN)
- …manual for all providers in the Emergency Department. Work with the VA Utilization Management (UM) department staff to monitor the preadmission screening process ... and administrative functions of the Emergency Department physicians and nurse practitioners. Responsibilities VA offers a comprehensive total rewards package.… more
- Elevance Health (Indianapolis, IN)
- …required. **Preferred Capabilities, Skills and Experiences:** + Previous experience in case management / utilization management with a broad range of ... a related behavioral health field or a degree in nursing , and minimum of 3 years of experience with...experience preferred. + Inpatient psychiatric hospital experience preferred. + Utilization review management experience preferred. + Strong… more
- Humana (Indianapolis, IN)
- …products including Word, Excel and Outlook **Preferred Qualifications** + Appeals/ Utilization Review/Quality Management experience + Previous claims experience ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more