- Humana (Hartford, CT)
- …help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge ... three (3) years of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from… more
- Humana (Hartford, CT)
- …+ 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 in… more
- Veterans Affairs, Veterans Health Administration (Leeds, MA)
- …after complete review of the EDRP application. Responsibilities This Registered Nurse (Acute Mental Health) position is located in the Nursing Services at the ... Leeds, MA location. This position is full time at 40 hours per week. Included but are not limited...customer service programs. The psychiatric Mental Health (MH) Registered Nurse provides and leads the provision of competent, evidence-based… more
- Trinity Health (Springfield, MA)
- …Nursing BSN degree preferred. + **Experience:** 3-5 years in Case Management, Utilization review , or similar experience preferred. Hospital or community-based ... program. BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS (AHA/ARC). CCM or ACM… more
- Trinity Health (Springfield, MA)
- …preferred. **Preferred Skills:** + **Experience:** 3-5 years in Case Management, Utilization review , or similar experience preferred. Hospital or community-based ... program. BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS (AHA/ARC). CCM or ACM… more
- Humana (Hartford, CT)
- …may include, but not be limited to, Pre-Certification, Care Management, Utilization Management, and/or Compliance. + Plans, coordinates, and implements training ... update training for UM nurses. + Develops programs to improve UM nurse competencies (critical thinking skills, interpreting criteria, communication with providers to… more
- The Cigna Group (Bloomfield, CT)
- …addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of ... plan to support appeal resolution. This position is full-time ( 40 hours/week) with the scheduled core business hours generally...limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C… more