- Kaiser Permanente (Roseville, CA)
- …of care. Develops and coordinates the plan of care and provides case management . Performs duties consistent with the nursing practice act that includes the standards ... patient's equipment needs. 6. Initiates preventative and rehabilitative nursing procedure ( Home Health). 7. Initiates timely discharges based on goals. 8. Educates… more
- Fresenius Medical Care (Reno, NV)
- …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
- Humana (Carson City, NV)
- …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 (Carson City, NV)
- **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
- CenterWell (Carson City, NV)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Carson City, NV)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- CVS Health (Carson City, NV)
- …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
- Sutter Health (Yuba City, CA)
- …team to implement the established plan of patient care and ensuring effective management of visit utilization and control of expenses. May assist in ... glad you are interested in joining Sutter Health! **Organization:** SCAH-Sutter Care at Home - Yuba City **Position Overview:** An experienced RN who is responsible… more
- Molina Healthcare (Reno, NV)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Sharecare (Carson City, NV)
- …/ 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
