- Evolent (Charleston, WV)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Sharecare (Charleston, WV)
- …affordable for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals ... and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Elevance Health (Charleston, WV)
- RN Utilization Management/ Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review ) is responsible for...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- BrightSpring Health Services (Dunbar, WV)
- …of death and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate ... health services for all assigned service sites. Provides oversight and direction for clinical services, and health & wellness for all clients in assigned area of… more
- CVS Health (Charleston, WV)
- …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- CVS Health (Charleston, WV)
- …clients - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits - Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- CVS Health (Charleston, WV)
- …a member's overall health through integration. + Through the use of clinical tools and information/data review , conducts comprehensive assessments of member's ... implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member… more
- Sedgwick (Charleston, WV)
- …Candidates must live within the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on ... Fortune Best Workplaces in Financial Services & Insurance Remote Accommodations Clinical Specialist- Bilingual Hindi, Japanese, Mandarin or more **We are looking… more
- CenterWell (South Charleston, WV)
- …first** The Patient Services Coordinator, LPN/LVN acts as a vital link between clinical staff and patients, along with their families and caregivers. Responsible for ... from the field staff and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary. + Maintains the client hospitalization… more
- Public Consulting Group (Charleston, WV)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... efficient, equitable, and client-centered * Handles case assignments, draft service plans, review case progress, and manages ongoing care needs * Travels within the… more
- Sedgwick (Charleston, WV)
- … Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience ... Services & Insurance RN Consultant Sr - Professional Liability **Prior Legal Nurse Consulting expereince highly preferred in order to be considered.** **PRIMARY… more
- Public Consulting Group (Charleston, WV)
- …efficient, equitable, and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels within the State ... patients make informed decisions by acting as their advocate regarding their clinical status and treatment options + Develops effective working relations and… more