- Cognizant (Pierre, SD)
- …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 (Pierre, SD)
- **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 (Pierre, SD)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient… more
- CVS Health (Pierre, SD)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Humana (Pierre, SD)
- **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
- Avera (Pierre, SD)
- …undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse (RN) - Board of Nursing An active license ... and manage any personnel/patient issues in the absence of clinical leaders. + Coordinates utilization of resources...the absence of clinical leaders. + Coordinates utilization of resources including staff, ancillary staff, equipment and… more
- CVS Health (Pierre, SD)
- …a member's overall wellness through integration. - Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and ... functions as well as smooth transition to programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and… more
- Humana (Pierre, SD)
- …help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation ... of action. The Utilization Management Behavioral Health Nurse uses clinical knowledge, communication skills, and...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no… more
- CVS Health (Pierre, SD)
- …performing the job functions. **Required Qualifications** - 5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty. - A ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that... Registered Nurse that holds an unrestricted license… more
- Datavant (Pierre, SD)
- …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
- STG International (Pierre, SD)
- …the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse (RN)/CBOC Manager and VA Program's philosophy. *Comply ... into the VA health care system. *Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership… more
- Highmark Health (Pierre, SD)
- …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
- CVS Health (Pierre, SD)
- …conditions. + **Diabetes education experience** is required. + Current, unrestricted ** Registered Nurse (RN) license** ; multi-state licensure preferred. + ... health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care,… more