- Elevance Health (Seattle, WA)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Healthfirst (WA)
- …Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care** + **Relevant clinical work experience** ... team in order to maximize HF member care quality while achieving effective medical cost management ** + **Assists in identifying opportunities for and… more
- Molina Healthcare (Bellevue, WA)
- …licensure required **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ( ... Services Auditor performs auditing of clinical staff in Utilization Management ( UM ), Case Management (CM),...them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Pacific Medical Centers (Renton, WA)
- …+ Coursework/Training Nursing (must be RN ) And + Upon hire: Washington Registered Nurse License + 5 years Clinical experience **Preferred Qualifications:** + ... RN is responsible for the supervision of case management (CM) and utilization management ( UM...Medical Director(s) to develop and implement strategic case management and utilization management yearly goals. Providence… more
- Humana (Olympia, WA)
- …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Molina Healthcare (Vancouver, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary The Care Review Clinician ( RN ) provides support for clinical member services review...promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications… more
- Molina Healthcare (Vancouver, WA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Molina Healthcare (WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2… more
- Molina Healthcare (WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2… more
- Whidbey General Hospital (Coupeville, WA)
- …etc. The RN - Care Manager follows the hospital's Case Management /Utilization Plan that integrates the functions of utilization review, discharge planning, and ... management either during admission or post discharge. The RN - Care Manager acts as a resource to...Patient Access, Patient Financial Services (PFS) and Health Information Management (HIM), as appropriate. + Escalates Medical … more
- Highmark Health (Olympia, WA)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
- CVS Health (Olympia, WA)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more
- CVS Health (Olympia, WA)
- … Management ( UM ) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... includes reviewing written clinical records. **Key Responsibilities of the UM Nurse Consultant** (Includes but is not...of Healthcare Services and benefit utilization. **Required Qualifications** + Registered Nurse ( RN ) with current… more
- Evolent (Olympia, WA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
- Humana (Olympia, WA)
- …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
- Highmark Health (Olympia, WA)
- …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more