- Moses/Weitzman Health System (Meriden, CT)
- …component meeting client's health care needs. Participates with Community Health Center management in developing and achieving optimal clinical performance and ... licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or… more
- PharmaCord (Hartford, CT)
- …Utilization Management , Call Center Case Management , a plus. Case management or Clinical Trial Nurse experience, a plus. Bachelor's degree ... independently while collaborating to share ideas, support, and resources. As a Nurse Advocate you are responsible for contact with program patients and assessing… more
- CVS Health (Hartford, CT)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Hartford, CT)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Hartford, CT)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Evolent (Hartford, CT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Hartford, CT)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Hartford, CT)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Hartford HealthCare (Hartford, CT)
- …Diseases provides inpatient and outpatient consultation regarding the diagnosis and management of all types of infectious diseases. The service is supported ... by outstanding clinical diagnostics laboratories, which provide state-of-the-art techniques for rapid...the framework for professional nursing practice, the Community Care Nurse Navigator is a registered nurse experienced… more
- Highmark Health (Hartford, CT)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Molina Healthcare (Rockville, CT)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in... Practitioner will be required to work primarily in non- clinical settings and provide medical care to all levels… more
- Hartford HealthCare (Hartford, CT)
- …context of the framework for professional nursing practice, the Cystic Fibrosis Clinic Nurse Navigator is a registered nurse experienced in patient throughput, ... skilled nursing care to patients in a variety of clinical settings. Scope of responsibility is characterized by use...standards, protocols and guidelines. This position reports to a Nurse Manager Manager. **Job Responsibilities:** * Functions as a… more
- Molina Healthcare (Rockville, CT)
- …primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing ... post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings… more
- Eastern Connecticut Health Network (Vernon, CT)
- …degree program. + Possession of a current license to practice as a Registered Nurse in the State of Connecticut. EXPERIENCE: + One (1) year of experience in ... identifying patient-related problems and recommending solutions. + Skill in documentation in clinical records and use of Electronic Medical Record. + Skill in… more
- Hartford HealthCare (New Britain, CT)
- …balance. Every moment matters. And this is *your moment*. **Job:** ** Management * **Organization:** **New Britain General* **Title:** *Assistant Nurse Manager ... Job Summary* The Assistant Nursing manager is a Registered Nurse (RN) who has responsibility for the supervision of...who has responsibility for the supervision of patient care, clinical personnel, and unit operations. This position supervises a… more
- Evolent (Hartford, CT)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- CVS Health (Hartford, CT)
- …every day. **Position Summary** Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical ... requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. This position… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- Fresenius Medical Center (East Hartford, CT)
- …(QAPI) documentation and attends QAPI meetings at a frequency determined by Clinical Quality leadership. Collaborates with facility management staff to evaluate ... **EXPERIENCE AND SKILLS:** + 3+ years dialysis experience required + 3+ years management experience in a clinical leadership role + Strong organizational,… more
- Hartford HealthCare (Hartford, CT)
- …specialties. The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, ... Medical Weight Loss team, and the Quality Department to identify opportunities for clinical excellence and special projects. The MBSCR is granted access to all… more
