- Humana (Richmond, VA)
- **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...to make an impact** **Required Qualifications** + Active enhanced Registered Nurse , (eNLC) license (RN) with no… more
- CVS Health (Richmond, VA)
- …both verbal and written. **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. + Must have active ... current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- Summary Registered Nurse - Inpatient Case Manager (Acute Medicine) position is located at the Richmond Veterans Affairs Medical Center in Richmond, Virginia. ... learn more about the position below, along with the duties. Responsibilities The Registered Nurse (RN), Inpatient Case Manager (Acute Medicine) is responsible… more
- Bon Secours Mercy Health (Petersburg, VA)
- …**Full-time night shift/12hr shifts** **Summary of Primary Functions** The Critical Care Registered Nurse (RN) provides, coordinates, plans, and evaluates the ... months of hire) TNCC Trauma Nursing Core Course (preferred) CCRN Critical Care Registered Nurse (preferred) PCCN Progressive Care Certified Nurse (preferred)… more
- Sharecare (Richmond, VA)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting...disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations… more
- Bon Secours Mercy Health (Richmond, VA)
- …to create an environment where associates want to work and help communities thrive. ** Registered Nurse (RN) - Clinical Nurse Educator - Physician Office ... model into care delivery **EMPLOYMENT QUALIFICATIONS:** Must be currently licensed as a Registered Nurse in the State of Virginia or awaiting reciprocity.… more
- Bon Secours Mercy Health (Richmond, VA)
- …Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. ** Registered Nurse (RN) - FT - Operating Room - St. Mary's ... partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based… more
- Bon Secours Mercy Health (Petersburg, VA)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... and assessment of individuals in need of active Case Management services and promotes the right resources, at the...+ Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial,… more
- Bon Secours Mercy Health (Midlothian, VA)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... and assessment of individuals in need of active Case Management services and promotes the right resources, at the...* Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial,… more
- Evolent (Richmond, VA)
- … Management 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 ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- United Therapeutics (Richmond, VA)
- …years of PAH nursing experience, including ICU and critical care of PAH patients + Registered Nurse (RN) - State Licensure and/or Compact State Licensure RN - ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...Registered Nurse - State Licensure and/or Compact… more
- Elevance Health (Richmond, VA)
- …on relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. **How you will ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....of the utilization reviews within the medical management processes. + Assesses and applies medical policies and… more
- CVS Health (Richmond, VA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CenterWell (Richmond, VA)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Highmark Health (Richmond, VA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse (RN) license + Delaware RN...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- Molina Healthcare (Richmond, VA)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who lives in South Carolina, Virginia, Tennessee, North Carolina, or Florida and ... and Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and… more
- HCA Healthcare (Richmond, VA)
- …+ **Performs other duties as assigned.** **Requirements:** + **Bachelors Degree** + ** Registered Nurse , or Occupational Therapy (OT), or Licensed Physical ... through clinical screenings and assessments in collaboration with both hospital Case Management and the Rehab Medical Director and works closely with hospital case… more
- Fresenius Medical Center (Richmond, VA)
- …and post procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Baylor Scott & White Health (Richmond, VA)
- …Should have a minimum of (2) two years relevant work experience. + Hold a valid Registered Nurse license (RN) As a health care system committed to improving the ... - must reside in North Texas or Central Texas Regions!** **Setting: Case Management - Post Partum/Prenatal Experience is a MUST** **Schedule: FT Monday-Friday 8:30am… more
- Bon Secours Mercy Health (Midlothian, VA)
- …+ BSN required / Masters degree preferred + **Licensure/Certification** **Required:** Registered Nurse Licensed in Virginia + Work requires previous ... Medical Center** **Positiona Summary** Responsible for the overall direction and management of the Surgical Services areas, to include the Pre-Admission Testing,… more