- Cognizant (Madison, WI)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for VISN 10 and/or ... of appropriate evidence-based practices for positive outcomes. Responsibilities The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is directly… more
- Humana (Madison, WI)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… more
- CVS Health (Madison, WI)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …teams to enhance patient care and workforce efficiency. Responsibilities The Registered Nurse - Nursing Informatics - Clairvia Solution Administrator/Staffing ... departments to optimize staffing practices in alignment with organizational goals. The Registered Nurse - Nursing Informatics exercises leadership in the… more
- CVS Health (Madison, WI)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Centene Corporation (Madison, WI)
- …required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required or + ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Madison, WI)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years ... we do it all with heart, each and every day. **Position Summary** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization… more
- Evolent (Madison, WI)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Molina Healthcare (Madison, WI)
- …or equivalent combination of relevant education and experience. * Advanced Practice Registered Nurse (APRN) license. License must be active and unrestricted ... * At least 8 years of health care experience, including 5 years of clinical practice experience, 3 years utilization /quality program management experience, and 2… more
- Molina Healthcare (Madison, WI)
- …on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in ... on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in… more
- Molina Healthcare (Madison, WI)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....or modification of payment decisions. * Serves as a clinical resource for utilization management, chief medical… more
- Sharecare (Madison, WI)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Molina Healthcare (Madison, WI)
- …for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- Meriter-UnityPoint Health (Madison, WI)
- …driver's license when driving any vehicle for work-related reasons. + Currently licensed as Registered Nurse and able to practice in the State of Wisconsin. + ... Psychiatry OP Location:Child/Adolescent Psych Hospital Job Description: The Child and Adolescent Clinical Resource Nurse and Outpatient Case Manager serves four… more
- Molina Healthcare (Madison, WI)
- …* At least 3 years health care management/leadership experience. * Registered Nurse (RN) or other advanced clinical or medical licensure. License must be ... active and unrestricted in state of practice. * Deep understanding of clinical operations: utilization management, care management, etc. * Ability to provide… more
- Molina Healthcare (Madison, WI)
- …behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... **Required Qualifications** + At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of… more
- SSM Health (Monroe, WI)
- …Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse (RN) Issued by Compact State + Or + Registered ... in standard work. + May also be responsible for: utilization management process, ED case management process, admission process,...of Professional Registration State of Work Location: Oklahoma + Registered Nurse (RN) Issued by Compact State… more
- Molina Healthcare (Madison, WI)
- …education and experience. r equivalent combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... deadlines. Excellent organizational, problem-solving and critical-thinking skills. Preferred Qualifications + Registered Nurse (RN). License must be active and… more