- Humana (Concord, NH)
- **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 (Concord, NH)
- **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 (Concord, NH)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- CVS Health (Concord, NH)
- …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 (Concord, NH)
- …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
- Dartmouth Health (Lebanon, NH)
- …Objective * The Case Manager will spend time specific to the role of case management and utilization review: * Lead a collaborative process with the members of ... nursing required; Master's preferred. * Licensed as a Registered Nurse in the State of New Hampshire. * BCLS...30 days of hire. * Board Certification in Case Management (CCM or CMC) preferred. If not certified, willingness… more
- Humana (Concord, NH)
- …degree in a related field + Health Plan experience + Previous experience in utilization management , discharge planning and/or home health or rehab + Bilingual is ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...and wellbeing of members. The NICU Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require… more
- Evolent (Concord, NH)
- …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
- Highmark Health (Concord, NH)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Dartmouth Health (Lebanon, NH)
- …based in Lebanon NH Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces care standards ... and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources. Responsibilities * Facilitates the development of a plan of… more
- Dartmouth Health (Lebanon, NH)
- …a Per Diem Float position Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces care standards ... and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources Responsibilities 1. Facilitates the development of a plan of… more
- Sharecare (Concord, NH)
- …/ 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
- Dartmouth Health (Lebanon, NH)
- …education experience with previous administration or directorial experience. Previous management experience in an emergency department (ED) environment. * Experience ... * LICENSE/CERTIFICATIONS/REGISTRATIONS SKILLS (Tracked at the department level) Licensed Registered Nurse with NH eligibility * ACLS required * Position Physical… more