- CVS Health (Indianapolis, IN)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Indianapolis, IN)
- …help us put health first** Full-Time, Remote Telephonic opportunity 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
- Cognizant (Indianapolis, IN)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … 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, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Indianapolis, IN)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Indianapolis, IN)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Indianapolis, IN)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Evolent (Indianapolis, IN)
- …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 ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Indianapolis, IN)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Elevance Health (Indianapolis, IN)
- RN - Utilization / Medical Management Nurse... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience; ... - 6pm PST. Rotating Weekends and holidays. The **Medical Management Nurse ** is responsible for review of...Med/Surg, Critical Care, ER, Telemetry, etc. strongly preferred. + Utilization management /review within managed care or hospital… more
- Sharecare (Indianapolis, IN)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… 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 ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Highmark Health (Indianapolis, IN)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more
- Evolent (Indianapolis, IN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Indianapolis, IN)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Elevance Health (Indianapolis, IN)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- CenterWell (Avon, IN)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... you to sit on-site at our** **Avon, IN** **branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by … more
- Elevance Health (Indianapolis, IN)
- …Requires HS diploma or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and ... Medical Management Clinician Associate - 40 hours, 4-5 days/week,...ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines… more
- Highmark Health (Indianapolis, IN)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more