- Humana (Concord, NH)
- **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
- Humana (Concord, NH)
- **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 (Concord, NH)
- …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
- Lincoln Financial (Concord, NH)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- CVS Health (Concord, NH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ... As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and...acute care setting with discharge planning, continuing care, care management , and utilization review. + Five years… more
- Beth Israel Lahey Health (Exeter, NH)
- Registered Nurse Case Manager + Full Time + Exeter, NH 03833 ... one weekend per month (may change), alternating holiday rotation The Nurse Case Manager/Discharge Planner collaborates, facilitates and negotiates the delivery of… more
- Elevance Health (Manchester, NH)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Elevance Health (Manchester, NH)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Highmark Health (Concord, NH)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Concord, NH)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Beth Israel Lahey Health (Exeter, NH)
- Clinical Resource Nurse + Part Time + Exeter, NH 03833 (https://maps.google.com/maps?q=Exeter%2C%20NH%20%2003833&zoom=14&size=512x512&maptype=roadmap&sensor=false) + ... 18 months of hire **Major Responsibilities:** 1. Assumes responsibility for clinical management functions on the assigned shift. 2. Models excellence in nursing… more
- Fresenius Medical Center (Lowell, MA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Highmark Health (Concord, NH)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Tufts Medicine (Lowell, MA)
- …Reporting to the Vice President of Patient Care Services and Chief Nurse Executive, this position has oversight of all clinical and administrative functions ... of the case management and social work departments in a four-time designated...programs of care. 11. Monitors and critically analyzes resource utilization of the unit. 12. Collaborates with physicians, hospital… more
- HCA Healthcare (Derry, NH)
- …Registered Nurse license + Two or more years of clinical experience. + Case Management , Utilization & Managed Care experience and 1 or more years of ... medical necessity, admission status, level of care, and resource management . + The RN Case Manager Team Lead will...supporting a balance of optimal care and appropriate resource utilization . + The RN Case Manager Team Lead will… more
- WellSense (Manchester, NH)
- …circumstances. **Job Summary** The Clinical Care Manager provides holistic medical care management services for members throughout the continuum of care by assessing ... team to develop an Individual Care Plan (ICP) that emphasizes self- management goals, care coordination, psychosocial, socioeconomic, and community-based supports and… more
- Sharecare (Concord, NH)
- …/ 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
- Molina Healthcare (Lowell, MA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... looking for a candidate with a MA RN licensure. Candidates with case management and home health are highly preferred. Bilingual candidates are encouraged to apply… more
- Lawrence General Hospital (Lawrence, MA)
- …measurement, monitoring, analysis, reporting, and adjusting the direction, allocation and utilization of available resources. The ACNO, Critical Care, serves as a ... License/Certification: Current, active, unencumbered RN license required. ANCC Certification, Nurse Executive NE-BC, NEA-BC, CEN, or equivalent leadership/clinical credentials.… more