- StaffDNA / Santa Fe Service Unit (PHS Indian Hospital) (Santa Fe, NM)
- …08/25/2025 End Date 03/31/2026 Duration 32 Week(s) Job Description Job Title : Case Manager Registered Nurse (RN) Job Summary : A Case Manager Registered ... in Nursing (BSN) preferred; Associate Degree in Nursing (ADN) accepted. Licensure : Valid Registered Nurse (RN) license in the state of practice. Certification :… more
- Cognizant (Santa Fe, NM)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Santa Fe, NM)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Humana (Santa Fe, NM)
- **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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Sharecare (Santa Fe, NM)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Lincoln Financial (Santa Fe, NM)
- …**What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible… more
- Molina Healthcare (Santa Fe, NM)
- …driver's license **PREFERRED EDUCATION:** **PREFERRED EXPERIENCE:** + 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a ... **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary... Practitioner will be required to work primarily in non- clinical settings and provide medical care to all levels… more
- Molina Healthcare (Santa Fe, NM)
- …for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- Molina Healthcare (Santa Fe, NM)
- …* Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse (RN). License must be active and unrestricted ... least 3 years management/leadership experience in a clinical leadership, clinical systems and/or informatics, utilization management, or care management… more
- Molina Healthcare (Santa Fe, NM)
- …behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... **Required Qualifications** + At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of… more
- Molina Healthcare (Santa Fe, NM)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or… more
- Molina Healthcare (Santa Fe, NM)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Molina Healthcare (Santa Fe, NM)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
