- ICW Group (Lisle, IL)
- …assessment and evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical ... regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… more
- Humana (Hallandale Beach, FL)
- …ensure interaction between the company and members are optimized. The Telephonic Behavioral Health Care Manager Internship provides transitioning service members ... requirements to achieve and/or maintain optimal wellness state in a remote telephonic environment. The Behavioral Health Care Manager guides members and/or families… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- AdventHealth (Altamonte Springs, FL)
- …or medical necessity by securing Independent Medical Examinations or submitting formal Utilization Review with clinical director and claims adjuster approval and ... **Location:** Remote **The role you'll contribute:** A Workers Comp Support Registered Nurse is responsible for providing telephonic medical case management for… more
- Sharecare (Columbia, SC)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and objectives of the… more
- Option Care Health (Austin, TX)
- … telephonic nursing support and management. + Provide excellent communication to nurse colleagues regarding patients on service with review of current status, ... best and brightest talent in healthcare. **Job Description Summary:** Responsible for telephonic management of patients at the telephonic center. **Job… more
- CVS Health (Springfield, IL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Topeka, KS)
- …with transferring patients to lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation preferred - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Baystate Health (Springfield, MA)
- **RN, ACO Nurse Care Manager, Community Health Center** The **ACO Nurse Care Manager i** s responsible for the management of care for a defined group of patients ... face visits, home visits if necessary, as well as telephonic interactions. In addition, they will assist with advance...room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: 1190 ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more
- NJM Insurance (Trenton, NJ)
- …Workers' Compensation line of business by performing prospective and retrospective Utilization Review of pharmaceutical/medication requests in accordance with ... and causally related. + Evaluate requests that are routed for clinical review based upon established criteria to issue appropriate and timely determinations on… more
- CVS Health (Charleston, WV)
- …and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. What you will ... do: + Responsible for telephonic and/or face to face assessment, planning, implementing and...+ Through the use of clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends… more
- Cardinal Health (Casper, WY)
- …safe and effective transitions of care across settings, reducing avoidable hospital utilization , and promoting chronic disease management. The nurse collaborates ... and external customers. The Value-Based Care / Transition of Care Registered Nurse plays a critical role in enhancing patient outcomes and supporting healthcare… more
- Albany Medical Center (Albany, NY)
- …the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN), the RN may provide ... direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's...or APP and documents results in EHR + Performs review and triage of incoming test results, patient requests… more
- CVS Health (Franklin, KY)
- …+ Discharge Planning Experience + Motivational Interviewing skills + Managed Care/ Utilization Review Experience + Clinical experience and demonstrated knowledge ... do it all with heart, each and every day. **Position Summary** The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- CVS Health (Tallahassee, FL)
- …to their next care setting. **Position Responsibilities:** . Responsible for telephonic and/or face to face assessing, planning, implementing, and coordinating all ... overall wellness through integration. . Using clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends an… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
- Guthrie (Sayre, PA)
- …leadership and autonomy in nursing practice. Preferred experience with care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... On Bonus For Qualified RNs! Summary: The Care Coordinator-Transitional Care provides telephonic outreach to all patients that have been discharged from an inpatient… more
- UPMC (Pittsburgh, PA)
- …will support Shadyside Family Practice onsite in Shadyside and may provide telephonic support to other practices. The position will work standard daylight hours, ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
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