- Premera Blue Cross (Mountlake Terrace, WA)
- …Blue Cross, a nationally recognized leader in the practice of integrated case management , is looking to expand our growing team of Case Managers.? Our comprehensive, ... lead to self-care. In the interim, case managers employ an integrated case management approach that recognizes making lifestyle changes is not simple and meets… more
- CVS Health (Olympia, WA)
- …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
- Humana (Olympia, WA)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Olympia, WA)
- …. 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
- Humana (Olympia, WA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Olympia, WA)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Olympia, WA)
- …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
- CVS Health (Olympia, WA)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Evolent (Olympia, WA)
- …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
- Elevance Health (Seattle, WA)
- RN - Utilization / Medical Management Nurse... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience; ... - 6pm PST. Rotating Weekends and holidays. The **Medical Management Nurse ** is responsible for review of...Med/Surg, Critical Care, ER, Telemetry, etc. strongly preferred. + Utilization management /review within managed care or hospital… more
- Sharecare (Olympia, WA)
- …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
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …The Home Based Primary Care (HBPC) Program Director is accountable for the management , supervision and evaluation of care for patients enrolled in the HBPC and ... all healthcare disciplines included on the HBPC teams. Responsible for directing the clinical and administrative services offered by the program to ensure that the… more
- Molina Healthcare (Vancouver, WA)
- …recommendations for denial or modification of payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, ... the payment Integrity analytical team; makes decisions and recommendations pertinent to clinical experience. * Facilitates document management , clinical … more
- CVS Health (Olympia, WA)
- …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
- General Dynamics Information Technology (Lakewood, WA)
- …a case manager by a recognized certifying organization, ie Commission for Case Management Certification or American Nurse Credentialing Center. + Current RN ... Seize your opportunity to make a personal impact as Nurse Case Manager supporting mission critical work on an...of professional health nursing principles, practices, and procedures in clinical settings to analyze the full scope of problems… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …refer to Required Documents below. Responsibilities The Critical Care Registered Nurse (RN) is responsible and accountable for individual nursing practice and ... determines the appropriate delegation of tasks consistent with the nurse 's obligation to provide optimal care. Has ability to formulate a plan of care based on… more
- Swedish Health Services (Seattle, WA)
- **Description** The Assistant Nurse Manager (ANM) is a professional Registered Nurse reporting to the unit director/manager who utilizes the nursing process to ... manage clinical and operational activities within assigned shift. The ANM...team environment. + Supervises in coordinating daily staffing and utilization of health care providers according to established standards… more
- Molina Healthcare (Bellevue, WA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Highmark Health (Olympia, WA)
- …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 (Tacoma, WA)
- …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
