- Cognizant (Charleston, WV)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… 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 ... SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action… 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no… more
- Humana (Charleston, WV)
- …make an impact** **Required Qualifications** + Associate's Degree or higher + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary ... health first** This is an opportunity to use your clinical knowledge and research skills to support the coordination,...an 8.5-hour shift between 7:00am - 5:00pm CST. The Utilization Management Nurse 2 uses knowledge, communication,… 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Charleston, WV)
- …RESIDE IN Kanawha, Fayette, Nicholas, Roane, Calhoun, Clay, Webster, Braxton, Gilmer** * Registered Nurse with current unrestricted West Virginia (WV) license or ... policies and programs are comprised of network management and clinical coverage policies. This position is heavy community-based with... Registered Nurse with current unrestricted WV or… more
- CenterWell (Charleston, WV)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Humana (Charleston, WV)
- …help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation ... Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no… more
- Humana (Charleston, WV)
- …**Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse (RN) Multi-state/Compact State license with no disciplinary ... medication adherence and is trained to act as a clinical concierge. The NAL Telephonic Nurse role...care, skilled or rehabilitation setting, home health, DME, triage, utilization , or case management. + **Ability to work ANY… more
- Sharecare (Charleston, WV)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- BrightSpring Health Services (Dunbar, WV)
- …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse (RN) in good standing and currently licensed by the ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least… more
- Datavant (Charleston, WV)
- …clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Highmark Health (Charleston, WV)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more