- Humana (Jefferson City, MO)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- Humana (Jefferson City, MO)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Jefferson City, MO)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Jefferson City, MO)
- …put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes behavioral health ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- AdventHealth (Kansas City, MO)
- …Wyandotte, Franklin, Douglas and Miami Counties in Kansas. **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a professional ... nurse who coordinates and directs the home care patients care based on individual patient needs....needs. The RN Care Manager is responsible for independent management of the Home Health patient population… more
- CVS Health (Jefferson City, MO)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Lincoln Financial (Jefferson City, MO)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at ...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
- Visiting Nurse Association of Southeast Missouri (Kennett, MO)
- …agency and regulatory standards, quality patient care, and effective and efficient resources utilization . + The Nurse Practitioner plays an integral part in the ... Biweekly Pay | Other We are looking for a Nurse Practitioner for our Palliative Care program. This program...patient visits, face to face encounters, and other patient management encounters. JOB DUTIES AND RESPONSIBILITIES Patient Care: +… more
- Evolent (Jefferson City, MO)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Fresenius Medical Center (Creve Coeur, MO)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Fresenius Medical Center (Normandy, MO)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- BJC HealthCare (St. Louis, MO)
- …plans to improve staff development. + Participates in program management , including licensing, budgeting, utilization and quality ... on job qualifications and relevant work experience) **Additional Information About the Role** BJC Home Care is looking for an experienced Home Health Manager to… more
- Children's Mercy Kansas City (Kansas City, MO)
- …from admission to discharge including ancillary services, physicians, pharmacy, and care management . This role requires that the Nurse Care Manager uses ... to promote safe, optimal, cost-efficient and satisfying patient/family outcomes. The Nurse Care Manager job functions include coordination of services for identified… more
- SSM Health (St. Charles, MO)
- …opportunities for improvement in standard work. + May also be responsible for: utilization management process, ED case management process, admission process, ... liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.). + Applies the existing body of...department's Scope of Service. + As an SSM Health nurse , I will demonstrate the professional nursing standards defined… more
- HCA Healthcare (Independence, MO)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...organizations. Apply Today! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care… more
- HCA Healthcare (Independence, MO)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...knowledge and expertise! **Job Summary and Qualifications** The Registered Nurse (RN) CM is responsible for promoting patient-centered care… more
- Sharecare (Jefferson City, MO)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- HCA Healthcare (Kansas City, MO)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...IQ criteria. + Adheres to HCA standards regarding observation management . In addition, the RN SM Lead will be… more
- HCA Healthcare (Kansas City, MO)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Research… more