- Omaha Children's Hospital (Omaha, NE)
- …councils to address performance improvement and processes. Communicates and collaborates with the Utilization Management (UM) Nurse , or other NCMs as ... care team to assess for diagnosis, care needs, and discharge plans. + Introduces Nurse Case Management (NCM) role to family. + Completes NCM assessment and… more
- Humana (Lincoln, NE)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Lincoln, NE)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Evolent (Lincoln, NE)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Molina Healthcare (Bellevue, NE)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Sharecare (Lincoln, NE)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Omaha Children's Hospital (Omaha, NE)
- …as necessary to coordinate care relating to regulatory requirements and benefits management ( Utilization management , authorizations team etc) * Identifies ... Maintains a central role in coordination, communication, education, and care management for timely, efficient, and cost-effective care across multiple healthcare… more
- Highmark Health (Lincoln, NE)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Lincoln Financial (Omaha, NE)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Evolent (Lincoln, NE)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- United Therapeutics (Lincoln, NE)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Molina Healthcare (Bellevue, NE)
- … 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
- Humana (Lincoln, NE)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Select Medical (Omaha, NE)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Omaha Children's Hospital (Omaha, NE)
- …strategic outcomes within the Cardiac Service Line. **Essential Functions** Operational Management + Ensures coordinated and high quality care across the continuum ... operational or financial plan. + Assure efficiencies in staffing and resource utilization by comparison with internal and external benchmarks as measured by… more
- Catholic Health Initiatives (Lincoln, NE)
- …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. + ... delivery of care in the appropriate setting. + Completes Utilization Management and screening for assigned patients....Current and valid license to practice as a Registered Nurse in the state of Nebraska. + Three to… more
- Pine Acres Rehabilitation & Care Center (Nebraska City, NE)
- …to Administrator Reporting to this position: None Job Classification: Registered nurse with administrative duties/ management Position Purpose: Conducts and ... current, unencumbered, active license to practice as a registered nurse in Nebraska. Must have 3 years' experience as...and timely reports to the DON, Facility Administrator, and management on issues relating to staffing, vacancies, agency use,… more
- Molina Healthcare (Bellevue, NE)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Catholic Health Initiatives (Omaha, NE)
- …in the lives of our patients!** We are seeking a compassionate and experienced Registered Nurse (RN) to join our team as a RN Care Coordinator. In this vital role, ... the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria. 5.… more
- Evolent (Lincoln, NE)
- …identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases for Care ... Management programs + Communicates appropriate information to other staff...as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of… more