- Elevance Health (Charleston, WV)
- RN Utilization Management / Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West ... Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review ) is...an equivalent background. + Current active, valid and unrestricted RN license to practice as a health professional within… more
- Sharecare (Charleston, WV)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- CVS Health (Charleston, WV)
- …2+ years CM, discharge planning and/or home health care coordination experience * Registered Nurse with active unrestricted state license in good standing within ... Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning,… more
- CVS Health (Charleston, WV)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Charleston, WV)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- Highmark Health (Charleston, WV)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sedgwick (Charleston, WV)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple ... business lines; and to provide expertise in client specific case management and utilization review requirements and ensure customer satisfaction through the… more
- BrightSpring Health Services (Dunbar, WV)
- …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse ( RN ) in good standing and currently licensed by ... and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate hours on… more