- Humana (Charleston, WV)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Charleston, WV)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Charleston, WV)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Charleston, WV)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Sharecare (Charleston, WV)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Evolent (Charleston, WV)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- CVS Health (Charleston, WV)
- …of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health ... and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member… more
- BrightSpring Health Services (Dunbar, WV)
- …of business development & growth, achievement of key performance indicators, management of nursing performance and staff development. Responsibilities * Oversees and ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...professional consultants and direct care in coordination with Operations management * Provides feedback to Operations management regarding… more
- CVS Health (Charleston, WV)
- …do it all with heart, each and every day. **Position Summary** The Care Management Associate (CMA) role is a full time remote telework position. Qualified candidates ... welfare population health members, and carries a caseload. The Care Management Associate supports comprehensive coordination of medical services including Care Team… more
- OhioHealth (Athens, OH)
- …and utilization of research to ensure evidence-based Nursing, health-care, management and administrative systems. Ensure the diversity and cultural competency of ... Officer is responsible and accountable for the overall delivery and management of nursing practice, nursing education and professional development, nursing research,… more
- Sharecare (Charleston, WV)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Amergis (Charleston, WV)
- …regarding accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more