- Humana (Indianapolis, IN)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Indianapolis, IN)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (Indianapolis, IN)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Indianapolis, IN)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- CVS Health (Indianapolis, IN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Evolent (Indianapolis, IN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Community Health Network (Indianapolis, IN)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and management and discharge planning. Has ... Registered Nurse (RN) Case Manager - East Emergency Department...2501140 Category Nursing Job Family Case Manager Department Case Management Schedule Full-time Facility Community Hospital East 1500 North… more
- Elevance Health (Indianapolis, IN)
- **Medical Management Nurse ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... will drive the future of health care. The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
- Sharecare (Indianapolis, IN)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Highmark Health (Indianapolis, IN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Indianapolis, IN)
- …required.** 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
- Evolent (Indianapolis, IN)
- …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
- Elevance Health (Indianapolis, IN)
- …nursing preferred. + Participation and/or certification in a managed care or utilization management organization preferred. + Ability to understand clinical ... and quality of life through home-care and community based services The **Triage Nurse I - Carebridge - Bilingual** is responsible for determining the appropriate… more
- Fresenius Medical Center (Shelbyville, IN)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- United Therapeutics (Indianapolis, IN)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Ascension Health (Indianapolis, IN)
- …areas of utilization criteria, appeal and review process, and case management system documentation. + Develop staff schedule and revise assignments daily to ... **Details** + **Department:** Inpatient Case Management + **Schedule:** Monday-Friday, 8:00AM-4:30PM, with some off shift work + **Hospital:** Ascension St. Vincent… more
- Humana (Indianapolis, IN)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Ascension Health (Indianapolis, IN)
- …+ Strong understanding of: + Discharge planning + Medicare/Medicaid regulations + Utilization review and management + Behavioral health and social determinants ... **Details** + **Department: Case Management - Central Region** + **Hospital: Ascension St. Vincent**...One or more of the following required: + Registered Nurse credentialed from the Indiana Board of Nursing obtained… more