- CVS Health (Charleston, WV)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Charleston, WV)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Charleston, WV)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Charleston, WV)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... 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 Appeals and… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Core elements ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Assist service chiefs, service line managers and others… more
- Evolent (Charleston, WV)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- BrightSpring Health Services (Dunbar, WV)
- …of business development & growth, achievement of key performance indicators, management of nursing performance and staff development. Responsibilities * Oversees and ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...professional consultants and direct care in coordination with Operations management * Provides feedback to Operations management regarding… more
- Fresenius Medical Center (Moorefield, WV)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Select Medical (Charleston, WV)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... Monday - Friday 8-5pm** **_Clinical license as a registered nurse or respiratory therapist or master's in social work...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more
- CVS Health (Charleston, WV)
- …of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health ... for career growth. We will support you all the way! The Care Management Associate (CMA) role is a full time remote telework position. Qualified candidates… more
- CenterWell (South Charleston, WV)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Sharecare (Charleston, WV)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Charleston, WV)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Charleston, WV)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Veterans Affairs, Veterans Health Administration (Clarksburg, WV)
- …not limited to) Physicians, Physician's Assistants, Nurses, Advanced Registered Nurse Practitioners, Dietitians, Social Workers, and other administrative and ... of information processes. The incumbent is responsible for accurate appointment management and the coordination of all administrative information between the… more
- Oracle (Charleston, WV)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- Genesis Healthcare (Logan, WV)
- …among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported by a clinical ... assigned Centers and AlignMed Partners managers to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs and… more
- Genesis Healthcare (WV)
- … Management and AlignMed Partners to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs. The Medical ... among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported by a clinical… more