- Humana (Olympia, WA)
- **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
- Molina Healthcare (Tacoma, WA)
- …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Swedish Health Services (Seattle, WA)
- …strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. ... education and training for staff and other health care providers regarding utilization management process, including but not limited to: reimbursement patterns,… more
- Molina Healthcare (WA)
- …decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/ appeals . + Provides training and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
- Molina Healthcare (WA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Everett, WA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more
- Providence (WA)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... are terminal and nearing end of life + Care management services include: nurse education, care coordination...Audits, Appeals or Delegation) + Experience working in a health… more
- Molina Healthcare (Tacoma, WA)
- …to provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Vancouver, WA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job… more