- Humana (Indianapolis, IN)
- **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 (Indianapolis, IN)
- **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 (Indianapolis, IN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- Fresenius Medical Center (Indianapolis, IN)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... quality of patient care, as defined by the quality goals, by working with management to ensure that policies and procedures are followed. + Assists with implementing… more
- CVS Health (Indianapolis, IN)
- …both verbal and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active ... current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and… more
- International Medical Group (Indianapolis, IN)
- …or tasks as assigned. QUALIFICATIONS + Current and active Nursing license - Registered Nurse + Minimum two years acute hospital-based experience providing direct ... large case management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for large case management… more
- Humana (Indianapolis, IN)
- …We are not able to hire candidates that are currently living in Puerto Rico. + Registered Nurse with current in-state RN license + At least 3 years of varied ... or comparable (such as Interqual, etc.) **Preferred Qualifications** + Utilization Review/Quality Management experience + BA/BSN degree **Work-At-Home… more
- Evolent (Indianapolis, IN)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed… more
- Elevance Health (Indianapolis, IN)
- …on relatively complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior clinicians. **How you will ... Capabilities, and Experiences:** + Prior claims experience is strongly preferred. + Utilization Management experience is strongly preferred. + Health insurance… more
- CenterWell (Avon, IN)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- CVS Health (Indianapolis, IN)
- …years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS Office suites - Must be ... year - Occasional travel less than 5% to complete audits/meetings - Utilization Management is a 24/7 operation and work schedules will include weekends,… more
- Highmark Health (Indianapolis, IN)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- STG International (Bloomington, IN)
- … management /coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse (RN)/CBOC Manager and VA Program's philosophy. + Comply ... to ensure compliance and patient safety. + Participate in quality improvement, care management , risk management , peer review, utilization review, clinical… more