- PharmaCord (Hartford, CT)
- …Utilization Management , Call Center Case Management , a plus. Case management or Clinical Trial Nurse experience, a plus. Bachelor's degree ... independently while collaborating to share ideas, support, and resources. As a Nurse Advocate you are responsible for contact with program patients and assessing… more
- Moses/Weitzman Health System (Hartford, CT)
- …component meeting client's health care needs. Participates with Community Health Center management in developing and achieving optimal clinical performance and ... licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or… more
- Commonwealth Care Alliance (Springfield, MA)
- …care to patients via telehealth technologies (ie, video, chat) for clinically appropriate clinical care and care management services Other duties as assigned ... the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care...(video, chat, etc.), when appropriate, for a variety of clinical care and care management services. **Required… more
- Commonwealth Care Alliance (Springfield, MA)
- …Conduct patient engagement via telehealth technologies (video, chat, etc.) for appropriate clinical care and care management services. + Conducting multiple ... is licensed in Massachusetts. **Required Experience (must have):** + 5+ years meaningful clinical care and care management experience with patients with complex… more
- CVS Health (Hartford, CT)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Hartford, CT)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Hartford, CT)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area - Managed Care experience preferred, especially Utilization Management Post Acute Experience **Education** Associates Degree required… more
- CVS Health (Hartford, CT)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Hartford, CT)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Evolent (Hartford, CT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Hartford, CT)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Commonwealth Care Alliance (Springfield, MA)
- …in primary care or care management , including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ ... the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management , and closing… more
- CVS Health (Hartford, CT)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Hartford HealthCare (Hartford, CT)
- …Diseases provides inpatient and outpatient consultation regarding the diagnosis and management of all types of infectious diseases. The service is supported ... by outstanding clinical diagnostics laboratories, which provide state-of-the-art techniques for rapid...the framework for professional nursing practice, the Community Care Nurse Navigator is a registered nurse experienced… more
- Baystate Health (Springfield, MA)
- …Health Center** The **ACO Nurse Care Manager i** s responsible for the management of care for a defined group of patients including complex care management , ... their care by acting as their advocate regarding their clinical status and treatment options. + Promotes quality and...management application is required and is vital. Care management program metrics including, emergency room utilization ,… more
- Highmark Health (Hartford, CT)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Molina Healthcare (Rockville, CT)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in... Practitioner will be required to work primarily in non- clinical settings and provide medical care to all levels… more
- Hartford HealthCare (Hartford, CT)
- …context of the framework for professional nursing practice, the Cystic Fibrosis Clinic Nurse Navigator is a registered nurse experienced in patient throughput, ... skilled nursing care to patients in a variety of clinical settings. Scope of responsibility is characterized by use...standards, protocols and guidelines. This position reports to a Nurse Manager Manager. **Job Responsibilities:** * Functions as a… more
- Molina Healthcare (Rockville, CT)
- …primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing ... post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings… more
- Eastern Connecticut Health Network (Vernon, CT)
- …degree program. + Possession of a current license to practice as a Registered Nurse in the State of Connecticut. EXPERIENCE: + One (1) year of experience in ... identifying patient-related problems and recommending solutions. + Skill in documentation in clinical records and use of Electronic Medical Record. + Skill in… more
