- Humana (Denver, CO)
- …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...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Humana (Denver, CO)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Humana (Denver, CO)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (Denver, CO)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... 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
- CenterWell (Denver, CO)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …satisfaction throughout the continuum of care. Responsibilities The Referral Coordination Team (RCT) Registered Nurse ( RN ) is responsible for executing a ... Summary The Referral Coordination Team Registered Nurse is responsible and accountable...of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community… more
- AdventHealth (Parker, CO)
- …need to succeed:** **Required qualifications:** + Associate's of Nursing + 2 Work Experience + Registered Nurse ( RN ) in state of CO or compact nursing ... satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily...(CCM) + Accredited Case Manager (ACM) + Experience in utilization management or case management … more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- Summary The Inpatient Acute Care Registered Nurse is responsible and accountable for all elements of the nursing process when providing and/or supervising direct ... patient care. The Registered Nurse is responsible for providing competent,...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- UCHealth (Aurora, CO)
- …3 years' experience. Preferred: Bachelor's degree in Nursing. + State licensure as a Registered Nurse ( RN ). Preferred: Basic Life Support (BLS) Healthcare ... cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care.… more
- Humana (Denver, CO)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Fresenius Medical Center (Denver, CO)
- …under the direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... This is a per diem RN position for our Denver, CO surgery center....adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other… more
- Highmark Health (Denver, CO)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Denver, CO)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- AdventHealth (Denver, CO)
- …(Required) **Licensure & Certifications** One of the following is **Required** : + ** Registered Nurse ( RN )** **OR** + **Physical Therapist (PT)** Preferred: ... + Performs duties of the clinical supervisor, intake, scheduling, quality review, utilization management , and medical records functions as needed. + Works… more
- Evolent (Denver, CO)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… more
- HCA Healthcare (Aurora, CO)
- …you will need:** Current licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure. BLS certification through ... join an organization that invests in you as a(an) RN Case Manager? At HCA HealthONE Aurora, you come...and family needs with the efficacious and cost effective utilization of resources. Through concurrent case management ,… more
- Elevance Health (Denver, CO)
- …required by law. The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... ** Nurse Case Manager II** **Hours: Monday - Friday...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Denver, CO)
- …the criteria._** The ** Nurse Case Manager II** is responsible for care management within the scope of licensures for members with complex and chronic care needs ... ** Nurse Case Manager II** **Location** : This role...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Denver, CO)
- …care. The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... **Telephonic Nurse Case Manager II** **Virtual:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Denver, CO)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more