- 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
- Healthfirst (IN)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… 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 ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in central zones.… more
- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require...one, (1), year of experience auditing and/or performing case management or utilization management chart… more
- CVS Health (Indianapolis, IN)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Community Health Systems (Fort Wayne, IN)
- …home health with excellent communication required + 2-4 years experience in case management or utilization management preferred **Knowledge, Skills and ... and disability insurance and more **Job Summary** The Manager of Care Management is responsible for the development, planning, coordination and administration of the… more
- Baylor Scott & White Health (Indianapolis, IN)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Evolent (Indianapolis, IN)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Humana (Indianapolis, IN)
- …part of our caring community and help us put health first** The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to ... medical services and/or benefit administration determinations. The Associate Director, Utilization Management Nursing requires a...of clinical experience + 2 or more years of management experience + Licensed Registered Nurse (RN)… 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
- CVS Health (Indianapolis, IN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- Select Medical (East Chicago, IN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Elevance Health (Indianapolis, IN)
- …required. **Preferred Skills, Capabilities and Experiences:** + Experience with Inpatient care management and utilization management highly preferred. + ... Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plansand providing clinical nursing support to develop,… more
- Elevance Health (IN)
- … preferred. + Participation and/or certification in a managed care or utilization management organization preferred. + Ability to understand clinical information ... a two-week period, including Saturday and Sunday every other weekend. The **Triage Nurse I - Carebridge** is responsible for determining the appropriate Care … more
- Elevance Health (Indianapolis, IN)
- …management plan and modifies as necessary. + Assists with development of utilization /care management policies and procedures. + Participates in or leads ... services in multiple states. + AS or BS in nursing preferred. Certification as a Case Manager is preferred....management experience and minimum of 1 year in Nurse Care Mgr II role or equivalent experience; or… more
- Ascension Health (Indianapolis, IN)
- …/ Certification / Registration: + One or more of the following required: + Registered Nurse credentialed from the Indiana Board of Nursing obtained prior to hire ... + Strong understanding of: + Discharge planning + Medicare/Medicaid regulations + Utilization review and management + Behavioral health and social determinants… more
- Elevance Health (Indianapolis, IN)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more