- Battelle Memorial Institute (Tacoma, WA)
- …two years' nursing experience + Current, full, active, and unrestricted license as a Registered Nurse in any US State, the District of Columbia, Guam, Puerto ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by State law **(Required)** + Three ... our Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator - Inpatient RN ** performs reviews of admissions and concurrent stay requests for… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + ... https://healthsource.premera.com/ . The **Care Coordinator - Retrospective** performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …preauthorization, outpatient and inpatient management, case management, retrospective claim review , and delegated management oversight. + Participate in the ... the adjustment and direction of work processes to support cost and utilization variations. + Participate in the development, implementation, and monitoring of the… more
- Parexel (Olympia, WA)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- Swedish Health Services (Seattle, WA)
- **Description** ** Utilization Review RN @...an accredited school of nursing. + Upon hire: Washington Registered Nurse License + 3 years ... you the chance to focus on what really matters - our patients.** The Utilization Review (UR) Nurse has a strong clinical background blended with a… more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization ... must empower them. **Required Qualifications:** + Upon hire: Washington Registered Nurse License + 3 years of...Or Associate's Degree in Nursing + 3 years of Utilization Review , Care Management, Quality Management, and/or… more
- Humana (Olympia, WA)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Molina Healthcare (WA)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
- Molina Healthcare (Spokane, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (WA)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Molina Healthcare (Spokane, WA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Molina Healthcare (WA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Whidbey General Hospital (Coupeville, WA)
- …background to assure compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning. The RN - Care Manager will lead an ... an RN + Minimum of two years current experience as an RN in utilization review , case management and/or discharge planning in a hospital inpatient acute… more
- CVS Health (Olympia, WA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- PeaceHealth (Vancouver, WA)
- …medical/surgical or related experience and supervisory/preceptor experience + Required: WA State Registered Nurse License + Required Upon Hire: Provider Basic ... **Description** PeaceHealth is seeking an experienced RN Case Manager for a per diem role...(Required) + Knowledge of discharge planning, health care reimbursement, utilization review processes and Medicare admission status/classification… more
- CenterWell (Kent, WA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Providence (Olympia, WA)
- …hires that meet required qualifications and conditions for payment.** The Inpatient Registered Nurse ( RN ) Care Manager provides professional, comprehensive, ... Degree Nursing degree/diploma upon hire + Upon hire: Washington Registered Nurse License + 2 years Acute...Inpatient setting + IRR or annual competency testing in Utilization Review **Preferred qualifications:** + Bachelor's Degree… more
- Molina Healthcare (Tacoma, WA)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Providence (Everett, WA)
- …and development. Apply now and be a part of something extraordinary!The Inpatient Registered Nurse ( RN ) Care Manager provides professional, comprehensive, ... Associate's Degree - Nursing degree/diploma upon hire. + Washington Registered Nurse License upon hire. + 2...+ 1 year - experience in care management or utilization review in any setting or successful… more
