- Cambia Health Solutions, Inc (Vancouver, WA)
- Care Management Nurse - Hybrid WA or...in Nursing or related field and 3 years of case management , utilization management , disease management ... OR - Vancouver ClinicPrimary Job Purpose The Care Management Nurse provides clinical care management (such as case management , disease management ,… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He… more
- Trinity Health (Albany, NY)
- …time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/ Hybrid (2 days Remote, 3 days ... in Office) **Position Summary** : The Registered Professional Utilization Management Lead is responsible for upholding...of nursing. 2. Current registration as a Registered Professional Nurse in New York State. 3. Bachelor of Science… more
- Humana (Columbus, OH)
- **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
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Universal Health Services (Temecula, CA)
- … Utilization Review Nurses who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs ... payer source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and… more
- Centene Corporation (Raleigh, NC)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Corewell Health (Southfield, MI)
- …everyone. Together, we are Corewell Health. Scope of work The Clinical Utilization Management (UM) Supervisor is responsible for monitoring, supervising, and ... performing daily Utilization Management functions, which includes but is...and complexity comparable to Corewell Health. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- Centene Corporation (Sacramento, CA)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Humana (Columbus, OH)
- …and help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health ... (3) years of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from… more
- Humana (Oklahoma City, OK)
- …documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are ... barriers to helping people achieve their best health. The Utilization Management (UM) Nurse 2...team **Work at Home Criteria** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided… more
- Houston Methodist (Houston, TX)
- + Registered Nurse preferred + RN with general medicine preferred + Hybrid position-Monday-Friday JOB SUMMARY At Houston Methodist, the Senior Service Line ... clinicians in a financially responsible manner. Under the direction of department management and in collaboration with key stakeholders, the Clinical Value Analysis… more
- Dignity Health (Rancho Cordova, CA)
- …the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of ... **Overview** This position is hybrid in-office and work from home.** Dignity Health...Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management… more
- Elevance Health (Columbus, OH)
- …you a check, or ask you for payment as part of consideration for employment. ** Utilization Management Representative I** + Job Family: CUS > Care Support + Type: ... VA, RICHMOND + VA, ROANOKE + Georgia, Atlanta + Ohio **Description** **Title: Utilization Management Representative I** **Location:** This position will work a … more
- Humana (Columbus, OH)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness ... Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Detailed working knowledge… more
- Elevance Health (Indianapolis, IN)
- …send you a check, or ask you for payment as part of consideration for employment. ** Utilization Management Rep I (US)** + Job Family: CUS > Care Support + Type: ... insightful analytics to improve the delivery of care. The Utilization Management Representative I is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Elevance Health (Columbus, OH)
- …+ New Jersey, Morristown **Description** **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits ... as part of consideration for employment. **Medical Oncology Medical Director - Utilization Review** + Job Family: MED > Licensed Physician/Doctor/Dentist + Type:… more
- Centene Corporation (Tallahassee, FL)
- …MONDAY-FRIDAY, 8AM - 5PM. THESE ROLES WILL BE SUPPORTING BEHAVIORAL HEALTH UTILIZATION MANAGEMENT FOR MEDICAID. **Position Purpose:** Performs a clinical review ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Salem, OR)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- WellSpan Health (York, PA)
- Case Management Nurse - Weekend Option -...+ 2 years Recent acute care experience. Required + Utilization management , case management , or ... Health, York, PA Schedule: Part Time Sign-On Bonus Eligible Remote/ Hybrid Regular Apply Now Tuesday, May 7, 2024 Virtual...General Summary Performs a variety of duties and applies utilization and case management techniques to determine… more
