- Parexel (Hartford, CT)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- CVS Health (Hartford, CT)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… more
- CVS Health (Hartford, CT)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing… more
- Humana (Hartford, CT)
- **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...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (Hartford, CT)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Hartford, CT)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- CVS Health (Hartford, CT)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- AccentCare, Inc. (Middlebury, CT)
- Overview Admissions Registered Nurse / RN , Hospice Location: Middlebury, CT Position: Admissions Registered Nurse / RN , Hospice Position Type: ... Find Your Passion and Purpose as a Hospice Admissions Registered Nurse Salary: $43 - $50 /...care we're building together. Be the Best Hospice Admissions RN You Can Be If you meet these qualifications,… more
- Highmark Health (Hartford, CT)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Hartford HealthCare (Hartford, CT)
- …continuum; identify risk factors; facilitate involvement of support services; perform utilization management functions; develop and implement transition planning ... consist of Registered Nurses experienced in discharge planning and case management and embrace a universal concept of patient advocacy. They are well supported… more
- Highmark Health (Hartford, CT)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Hartford HealthCare (Farmington, CT)
- …others as needed. **Education** . Bachelor degree or equivalent experience **Experience** . Minimum: Registered Nurse ( RN ) with 3-5 years CDS experience . ... CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as… more
- Hartford HealthCare (New Britain, CT)
- …experience required, BSN strongly preferred. Candidate with previous experience with utilization management and managed care. Excellent written and verbal ... coordinates and monitors the plan of care to achieve optimal resource utilization and discharge planning outcomes. Expedites value added interventions to achieve… more
- CVS Health (Hartford, CT)
- …+ 5-7 years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management (UM) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
- Evolent (Hartford, CT)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… more
- Elevance Health (Wallingford, CT)
- …Manager I** The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health and substance use disorder ... provide an equivalent background. + Current active unrestricted license, such as ** RN LCSW** **LMSW LMHC** **LPC** (as allowed by applicable state laws) **LMFT**… more
- Trinity Health (Hartford, CT)
- …**Minimum five years' experience in quality improvement, data collection and analysis or utilization management in a hospital setting required** + Current RN ... licensure in the State of Connecticut preferred + Master's Degree in Nursing preferred + Proficiency in data collection and data analysis for quality and safety performance improvement + Must be well versed in statistics, data analysis and statistical process… more
- Hartford HealthCare (Torrington, CT)
- …Hungerford Hospital on a daily basis *_EDUCATION_* * Maintains current license as a Registered Nurse in the State of Connecticut. * Bachelor's degree in Nursing ... convenient, safe and comfortable patient environment. *_POSITION SUMMARY/PURPOSE_* Care Management is a collaborative practice model including patients, nurses,… more
- Hartford HealthCare (New Britain, CT)
- …birth through the end of life. * Job Summary* The Assistant Nursing manager is a Registered Nurse ( RN ) who has responsibility for the supervision of patient ... roles preferred. 3-5 year leadership experience required. *Licensure, Certification, Registration* . Registered Nurse , State of CT . Certified in Basic Life… more
- Datavant (Hartford, CT)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
