- Humana (Honolulu, HI)
- **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
- Cognizant (Honolulu, HI)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... 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 Appeals and… more
- Lincoln Financial (Honolulu, HI)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... 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
- CVS Health (Honolulu, HI)
- …+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
- Highmark Health (Honolulu, HI)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Honolulu, HI)
- …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
- Queen's Health System (Honolulu, HI)
- …nursing and rehabilitation concepts. Other key responsibilities include patient/family education, utilization management , and coordination of care and discharge ... A. EDUCATION/CERTIFICATION AND LICENSURE: * Current Hawaii State license as a Registered Nurse . * Associate's or bachelor's degree in nursing * Valid US driver's… more
- Queen's Health System (Kamuela, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. **II. TYPICAL PHYSICAL DEMANDS:** * ... in Nursing preferred. * Current Hawaii State license as a Registered Nurse . * Current certification at BLS/HCP level. Additional certifications may be required… more
- Hawaii Pacific Health (Honolulu, HI)
- …long term care, or related field. **Preferred Qualifications:** Current Case Management or Utilization Management certification. EOE/AA/Disabled/Vets Hawai'i ... invasive cardiac surgery and total joint replacement. The Case Management team puts great emphasis on helping each patient...of medical, financial or social interventions. As the Registered Nurse Case Manager, you would ensure the considerate and… more
- Highmark Health (Honolulu, HI)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Queen's Health System (Honolulu, HI)
- …comparable role highly preferred. * Experience to demonstrate: o Knowledge of case management , utilization review processes and discharge management . o ... and clinical operations of Emergency Department and Inpatient Case Management services. * Develops, implements, monitors and evaluates for effectiveness,… more
- Sharecare (Honolulu, HI)
- …/ 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
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- Hawaii Pacific Health (Lihue, HI)
- …(CDI) certification. Experience with InterQual, Milliman or other nationally recognized Utilization Management criteria. Experience with DRGs or inpatient ... Range:** 127,691.20 - 159,619.20 USD per hour **Category:** Health Information Management **Minimum qualifications:** Current Hawai'i Registered Nurse License.… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- Queen's Health System (Ewa Beach, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more