- Premera Blue Cross (Mountlake Terrace, WA)
- …preauthorization, outpatient and inpatient management, case management, retrospective claim review , and delegated management oversight. + Participate in the ... the adjustment and direction of work processes to support cost and utilization variations. + Participate in the development, implementation, and monitoring of the… more
- Swedish Health Services (Seattle, WA)
- …be considered_** **Care Manager RN ** **Per diem / On call** **Day shift** The Utilization Review (UR) Nurse has a strong clinical background blended with ... a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination....(BSN) from an accredited school of nursing. + Washington Registered Nurse License upon hire. + 3… more
- Molina Healthcare (Bellevue, WA)
- … and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical...a hospital setting, including at least 1 year of utilization review , medical claims review ,… more
- Molina Healthcare (Bellevue, WA)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
- Molina Healthcare (Bellevue, WA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- CenterWell (Kent, WA)
- …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...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Pacific Medical Centers (Seattle, WA)
- …home insurance, commuter benefits and more! **Required Qualifications:** + Upon hire: Washington Registered Nurse License + Upon hire: National Provider BLS - ... Care patient in order to assure cost effective, appropriate utilization of health care resource. Nurse Case...Upon hire: Certified Case Manager + Previous experience in utilization review /case management. **Why Join Providence?** Our… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …(2) years of acute hospital clinical experience + Current licensure as a Registered Nurse in the state of Washington ( RN -WA) + BLS required within 3 months ... the way our patient care is delivered. As a Registered Nurse at Virginia Mason you are...+ Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used We deliver inspired… more
- Elevance Health (Seattle, WA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... Capabilities, Skills and Experiences:** + Medical Management experience is preferred, + Utilization Review experience is preferred. + Knowledge of the medical… more
- University of Washington (Seattle, WA)
- …to support successful testimony in ITA court + Attend treatment team, utilization review , quality improvement and other meetings as requested/required. Attend ... Degree as required by specialty + Licensed as a psychologist, advanced registered nurse practitioner, mental health counselor or independent clinical social… more
- Molina Healthcare (Bellevue, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary The Care Review Clinician ( RN ) provides support for...critical care experience, ie ER or ICU. Candidates with Utilization Management and med/surge experience are highly preferred. Exceptional… more
- Molina Healthcare (Bellevue, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Molina Healthcare (Bellevue, WA)
- …required **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), ... to resolve/correct them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and Associate's or… more
- Swedish Health Services (Seattle, WA)
- …beyond three years is contingent upon attaining the BSN degree + Upon hire: Washington Registered Nurse License + 3 years Registered nursing experience in an ... **Description** **Care Manager RN - Emergency Department @ Swedish First Hill**...focus on what really matters - our patients.** The nurse case manager coordinates the care and service of… more
- Pacific Medical Centers (Renton, WA)
- …+ Coursework/Training Nursing (must be RN ) And + Upon hire: Washington Registered Nurse License + 5 years Clinical experience **Preferred Qualifications:** + ... **Description** The Supervisor Care Management RN is responsible for the supervision of case...responsible for the supervision of case management (CM) and utilization management (UM) functions of US Family Health Plan… more
- LifeCenter Northwest (Bellevue, WA)
- …availability, evening, and weekend work. EDUCATION, EXPERIENCE & JOB REQUIREMENTS + Registered Nurse , Physician's Assistant, or other relevant health care ... donor management protocols aimed at optimizing organ function and increasing organ utilization . + Routinely reviews performance metrics and recommends changes in… more
- Elevance Health (Seattle, WA)
- **Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Elevance Health (Seattle, WA)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the… more
- Elevance Health (Seattle, WA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
