- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... Job Summary: Our Utilization Management Appeals Nurse -...requirements, including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies to physician reviewers for… more
- Elevance Health (Indianapolis, IN)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent ... the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Representative II** **Location** : This position will work remotely. The ideal candidate will live within 50 miles of one of the ... Atlanta, GA; Chicago, IL; Indianapolis, IN; Louisville, KY; The ** Utilization Management Representative II** is responsible for...the provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Medical Management II** At **Federal...3 years of acute care clinical experience or case management , utilization management or managed ... 7 pm (EST) shift rotation twice a month.** The ** Nurse Medical Management II** is responsible for...Will Make an Impact** + Conducts precertification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- Elevance Health (Indianapolis, IN)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- International Medical Group (Indianapolis, IN)
- …efficiency of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the ... management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for...PREFERRED SKILLS + BSN Preferred + Minimum two years utilization review with a managed care or… more
- Community Health Network (Indianapolis, IN)
- …continuity of care and cost effectiveness through the integrating and functions of case management , utilization review and management and discharge ... Registered Nurse (RN) Case Manager - Community Heart &...2402103 Category Nursing Job Family Case Manager Department Case Management Schedule Full-time Facility Community Heart & Vascular Hospital… more
- Fresenius Medical Center (Indianapolis, IN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Indianapolis, IN)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- CenterWell (Avon, IN)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Vyaire Medical (Indianapolis, IN)
- …within and across functional groups. Communicate information related to quality management system efficiency. + Directly support the timely and quality sale, ... of new products and services; make recommendations to drive client acceptance and utilization of new medical devices. Facilitate UPE's for new products. + Develop,… more