- Humana (Trenton, NJ)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Trinity Health (Langhorne, PA)
- …consumption, and acceptable clinical outcomes, through integration and implementation of utilization management . **Minimum Requirements:** + Bachelor's degree in ... of Trinity Health Mid-Atlantic, is seeking an experienced Registered Nurse to join our team in Utilization ...related to the clinical review and level of care. Management of all review and appeals utilizing… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… more