- Elevance Health (Denver, CO)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Healthfirst (CO)
- …Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care** + **Relevant clinical work experience** ... team in order to maximize HF member care quality while achieving effective medical cost management ** + **Assists in identifying opportunities for and… more
- Humana (Denver, CO)
- …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- CommonSpirit Health Mountain Region (Colorado Springs, CO)
- …total nursing experience required. + Certified Case Manager (CCM), Accredited Case Manager (ACM- RN ), or UM Certification preferred. + Experience working with EMR ... most diverse communities across the nation, letting humankindness lead the way. Overview: ** RN Case Managers may be eligible for a relocation bonus up to**… more
- Highmark Health (Denver, CO)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
- HCA Healthcare (Englewood, CO)
- …Licensure/Certification/Registration: o Current licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure, or LCSW ... years UM /CM experience required. o One to three years charge/lead/supervisory/ management experience required, in UM /CM department role preferred. Able to… more
- CVS Health (Denver, CO)
- … Management ( UM ) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... includes reviewing written clinical records. **Key Responsibilities of the UM Nurse Consultant** (Includes but is not...of Healthcare Services and benefit utilization. **Required Qualifications** + Registered Nurse ( RN ) with current… more
- HCA Healthcare (Englewood, CO)
- …Licensure/Certification/Registration: o Current licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure, or LCSW ... years UM /CM experience required. o One to three years charge/lead/supervisory/ management experience required, in UM /CM department role preferred. Able to… more
- Evolent (Denver, CO)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
- Humana (Denver, CO)
- …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
- Elevance Health (Denver, CO)
- …necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Highmark Health (Denver, CO)
- …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more