- 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...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (Madison, WI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Madison, WI)
- **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
- Molina Healthcare (Madison, WI)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Molina Healthcare (Madison, WI)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... must be technologically proficient, self-directed, autonomous and experience working from home . Care Management & Waiver Service Auditing experience is… more
- Evolent (Madison, WI)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- Elevance Health (Dodgeville, WI)
- …communities. The **LTSS Service Coordinator-RN Clinician** is responsible for overall management of member's case within the scope of licensure, develops, monitors, ... face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… more
- Fresenius Medical Center (Fitchburg, WI)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Molina Healthcare (Madison, WI)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Madison, WI)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- SSM Health (Madison, WI)
- …opportunities for improvement in standard work. + May also be responsible for: utilization management process, ED case management process, admission process, ... liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.). + Applies the existing body of...department's Scope of Service. + As an SSM Health nurse , I will demonstrate the professional nursing standards defined… more
- Sharecare (Madison, WI)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Molina Healthcare (Madison, WI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...hold a compact license. This is a Remote position, home office with internet connectivity of high speed required… more
- Wellpath (Madison, WI)
- …the organization's Code of Conduct. + Demonstrates knowledge of risk management , clinical precautions, infection control, fall prevention, utilization of ... discounts * Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits...+ Have and maintain current licensure as a Registered Nurse within the state of employment. + Obtain and… more