- 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)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN , for a limited period of time, ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… 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
- 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
- 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
- Evolent (Indianapolis, IN)
- …**Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + Associate or Bachelors in Nursing (Must ... , you will be a key member of the utilization management team. We can offer you a meaningful way...be a Registered Nurse ) - **Required** + You must be… more
- Elevance Health (Indianapolis, IN)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing. + Correlates review findings with ... ** Nurse Audit Sr.** **Hospital Billing - UB/IB Medical...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Sharecare (Indianapolis, IN)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... orientation and to take the pre and post-test to review competency during orientation. Yearly competency test is required...will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
- Elevance Health (Indianapolis, IN)
- …and outpatient professional treatment health benefits through telephonic or written review . **How You Will Make an Impact:** Primary duties may include ... equivalent background. + Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by...requirement for this position. + Previous experience in case management/ utilization management with a broad range of experience with… more