- 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 ... 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 (Honolulu, HI)
- …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 (Honolulu, HI)
- …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
- Centene Corporation (Honolulu, HI)
- …including a fresh perspective on workplace flexibility. Remote Position. Must Reside in Hawaii Registered Nurse ( RN ) or Licensed Clinician Only. Must have a ... license **Must have Behavioral Health and Substance Abuse experience. Utilization Management experience strongly preferred.** **Position Purpose:**...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… more
- Queen's Health System (Honolulu, HI)
- …patients' needs in accordance with the principles and practices of a registered nurse . Knowledgeable in community health nursing and rehabilitation concepts. ... Other key responsibilities include patient/family education, utilization management , and coordination of care and...AND LICENSURE: * Current Hawaii State license as a Registered Nurse . * Associate's or bachelor's degree… more
- Hawaii Pacific Health (Honolulu, HI)
- …organizations and other combinations of medical, financial or social interventions. As the Registered Nurse Case Manager, you would ensure the considerate and ... 159,619 USD per year **Category:** Nursing **Minimum Qualifications:** Current Hawai'i Registered Nurse license. Bachelor's degree and/or equivalent combination… more
- CVS Health (Honolulu, HI)
- …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 (Honolulu, HI)
- **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
- Highmark Health (Honolulu, HI)
- …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
- 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… 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 ... physical safety. IV. MINIMUM QUALIFICATIONS A. Education/Certification and Licensure: 1.Licensure: Registered Nurse , State of Hawaii 2.Diploma or Associate… more
- Highmark Health (Honolulu, HI)
- …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
- Evolent (Honolulu, HI)
- …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
- CVS Health (Honolulu, HI)
- …chronic conditions. + **Diabetes education experience** is required. + Current, unrestricted ** Registered Nurse ( RN ) license** ; multi-state licensure ... and ensures access to psychosocial support services. The goal is to optimize resource utilization and drive positive health outcomes. The RN will use strong… more
- Datavant (Honolulu, HI)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more