- Humana (Charleston, WV)
- **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 (Charleston, WV)
- **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
- Sharecare (Charleston, WV)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Humana (Charleston, WV)
- …degree in a related field + Health Plan experience + Previous experience in utilization management , discharge planning and/or home health or rehab + Bilingual is ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...and wellbeing of members. The NICU Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require… more
- Evolent (Charleston, WV)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- CVS Health (Charleston, WV)
- …of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health ... and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member… more
- Highmark Health (Charleston, WV)
- …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
- BrightSpring Health Services (Dunbar, WV)
- …of business development & growth, achievement of key performance indicators, management of nursing performance and staff development. Responsibilities * Oversees and ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...professional consultants and direct care in coordination with Operations management * Provides feedback to Operations management regarding… more
- Sharecare (Charleston, WV)
- …/ 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
- Amergis (Charleston, WV)
- …regarding accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more