- 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
- CVS Health (Denver, CO)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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
- CVS Health (Denver, CO)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… 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
- CommonSpirit Health (Longmont, CO)
- …discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical ... **Job Summary and Responsibilities** ** RN Case Managers may be eligible for a...Employment required + 1 year of nursing or case management experience required. + Experience working with EMR preferred.… more
- Intermountain Health (Brighton, CO)
- …Education + Communication + Prioritization **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of ... The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments,… 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
- CVS Health (Denver, CO)
- …+ 5-7 years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management (UM) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
- HCA Healthcare (Thornton, CO)
- …Position Requirements: + Current licensure in the State of Colorado as a Registered Nurse , or current active multistate Registered Nurse ... of clinical nursing experience in the acute care setting. Prior utilization /quality/discharge planning/and/or case management experience highly preferred. HCA… 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 (Thornton, CO)
- …Nursing Diploma Required Bachelor's Degree in Nursing Preferred + RN ) Registered Nurse + 2+ years experience in case management OR 3+ years experience in ... part of our team. **Job Summary and Qualifications** The Registered Nurse ( RN ) CM is...stay, managing the length of stay, ensuring appropriate resource management , and developing a safe appropriate discharge plan in… 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