- Ascension Health (Indianapolis, IN)
- …required. **Additional Preferences** We are seeking a dedicated, detail-oriented, and self-motivated Utilization Review Nurse to join our healthcare team. ... to ensuring the appropriate, efficient, and cost-effective use of healthcare resources. The Utilization Review Nurse will be responsible for reviewing… more
- Humana (Indianapolis, IN)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health… more
- CVS Health (Indianapolis, IN)
- …and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of residence. + 3+ years of Nursing ... experience. Preferred Qualifications + Prior authorization utilization management/ review experience preferred Outpatient Clinical experience. + Knowledge of… more
- Community Health Network (Indianapolis, IN)
- Registered Nurse ( RN ) Case Manager - North Job Ref 2501284 Category Nursing Job Family Case Manager Department Case Management Schedule Per Diem Facility ... PRN RN Case Manager opportunity available. The Registered Nurse Case Manager is responsible for...effectiveness through the integrating and functions of case management, utilization review and management and discharge planning.… more
- CenterWell (Avon, IN)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Fresenius Medical Center (Indianapolis, IN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Fresenius Medical Center (Lebanon, IN)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Humana (Indianapolis, IN)
- …consistent across markets. **Use your skills to make an impact** **Required Qualifications:** + Registered Nurse with a Bachelor's degree in Nursing, BSN, and an ... and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation...of hierarchy): MCG, ASAM, Market Policies and Handbooks, Peer Review Literature, etc. + Working knowledge of NCQA UM… more
- Trinity Health (Mishawaka, IN)
- …SUMMARY:** The inpatient **Certified Wound Ostomy Continency Consultant (CWOCN Consultant), Registered Nurse ** will provide clinical oversight and coordination ... Consultation, educational support and staff development activities that provide the bedside nurse with the knowledge, skills, and confidence to manage wounds will be… more
- HCA Healthcare (Terre Haute, IN)
- …communication skills in all forms . Graduate of an approved school of nursing . Licensed Registered Nurse in the State of Indiana . BSN or higher required. . ... previous managerial or leadership experience required. . Prior experience in utilization /quality review and/or PRO review required or equivalent experience… more
- Sedgwick (Indianapolis, IN)
- …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 provision of these… more
- STG International (Bloomington, IN)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement… more
- Lincoln Financial (Indianapolis, IN)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like… more
- Evolent (Indianapolis, IN)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology… more
- Parkview Health (Fort Wayne, IN)
- …installing systems to obtain precertification and recertification for payment and utilization review . Attends treatment planning to advise regarding ... (ASN); Bachelor of Science in Nursing (BSN) preferred. Licensure/Certification Current Indiana RN license. CPI required upon hire or within 3 months of employment.… more
- Community Health Systems (Fort Wayne, IN)
- …special focus on the clinical components of care/medical management, utilization /resource management and insurance issues. Collaborates with the physicians, ... needs, maximize patient, family and provider satisfaction, optimize resource utilization , facilitate timely discharge, assure appropriate length of stay, reduce… more
- Guardian Life (Indianapolis, IN)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- Highmark Health (Indianapolis, IN)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Ascension Health (Carmel, IN)
- …regular business hours + **Hospital:** Ascension St. Vincent + **Location:** Indianapolis, IN Registered Nurse in the State of Indiana. Bachelor's Degree. Must ... as content specialist for staff in the areas of utilization criteria, appeal and review process, and...Registration: One or more of the following required: + Registered Nurse credentialed from the Indiana Board… more
- State of Indiana (West Lafayette, IN)
- …employment: + License to practice nursing in the State of Indiana as a Registered Nurse . + Four (4) years full-time professional administrative or supervisory ... analyze on budget information and make recommendations to optimize utilization of resources. + Prepare and review ...optimize utilization of resources. + Prepare and review compliance reports to submit to the appropriate authority.… more