- Humana (Richmond, VA)
- …of action. The Utilization Management Nurse 2/Home Health Utilization Management : + Review cases using clinical knowledge, communication skills, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent ... the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to… more
- ChenMed (Richmond, VA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- Elevance Health (Richmond, VA)
- ** Nurse Medical Management II** At **Federal...3 years of acute care clinical experience or case management , utilization management or managed ... 7 pm (EST) shift rotation twice a month.** The ** Nurse Medical Management II** is responsible for...Will Make an Impact** + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- Elevance Health (Richmond, VA)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- HCA Healthcare (Richmond, VA)
- …nurse and/or delegates various tasks to staff RN's. Provides cross coverage for Utilization Review . + Maintains a competent staff through working with the ... **Description** **Introduction** We are seeking a(an) Psychiatric Nurse Manager with Parham Doctors' Hospital to promote...ability. Six months previous experience in an area of management or leadership. + Preferred - One year previous… more
- HCA Healthcare (Richmond, VA)
- …concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan + As a member of Case Management team ... experience as RN years demonstrated leadership experience + Commercial Utilization Management and/or Case Management ...encourage you to apply for our Case Manager Registered Nurse RN opening. We review all applications.… more
- Bon Secours Mercy Health (Richmond, VA)
- …sites and clinicians are recognized for clinical and operational excellence. **_Registered Nurse (RN) - 5S Ortho/Joint - St. Mary's Hospital:_** **_**up to $30,000 ... orientation program with dedicated preceptors, immersive experience with rehab services, service line nurse navigators and more! Program lasts up to 12 weeks, but is… more
- HCA Healthcare (Richmond, VA)
- …**3+ years of RN experience in a hospital setting preferred.** + **Previous case management or utilization review experience preferred.** CJW Medical Center ... opportunity to make a real impact. As a **Registered Nurse RN Case Manager** you can be a part...may vary by location._** We are seeking a **Registered Nurse RN Case Manager** for our team to ensure… more
- Bon Secours Mercy Health (Richmond, VA)
- …of Primary Function/General Purpose of Position** In the capacity of a Registered Nurse , the Ambulatory Care Manager will provide clinical care management ... Interviewing techniques as a patient-centered approach to activate patients in self- management of their chronic conditions with the goal of improved symptom… more
- Marriott (Richmond, VA)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- Molina Healthcare (Glen Allen, VA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... For this position we are seeking a (RN) Registered Nurse or LMHP who lives in VIRGINIA and must...years in one or more of the following areas: utilization management , case management , care… more
- Humana (Richmond, VA)
- …and external customers. + Develops education and training programs for LTSS Care Management team, inclusive of case review and case study. + Collaborates ... Healthy Horizons in Virginia is seeking a Director, Care Management of Long-Term Services and Supports (LTSS) who will...Virginia.** + Bachelor's degree. + An active unrestricted Registered Nurse (RN) license in Virginia. + Combination of eight… more