- Humana (Carson City, NV)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CVS Health (Carson City, NV)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CenterWell (Carson City, NV)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Evolent (Carson City, NV)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Evolent (Carson City, NV)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Evolent (Carson City, NV)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... NCH has business OTHER SKILLS and ABILITIES: Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic skills… more
- Molina Healthcare (North Las Vegas, NV)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- HCA Healthcare (Las Vegas, NV)
- …you want to join an organization that invests in you as a Director Case Management ? At Sunrise Hospital, you come first. HCA Healthcare has committed up to $300 ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… more
- Intermountain Health (Las Vegas, NV)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + BLS Certified **Physical ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- HCA Healthcare (Las Vegas, NV)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...continue to learn! **Job Summary and Qualifications** **The Registered Nurse (RN) CM is responsible for promoting patient-centered care… more
- Humana (Carson City, NV)
- …others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more
- University of Southern California (Las Vegas, NV)
- …patients with multiple low risk hospitalizations. + 15. Works with contracted utilization management company to discuss patients with complex diagnosis and/or ... examination and treatment plan made by physician assistants / nurse practitioners. Functions in supervisory role as needed. +...risk patients to appropriate specialty services, including assistance in management of home health needs. + 16.… more