- Humana (Santa Fe, NM)
- **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
- CenterWell (Santa Fe, NM)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Santa Fe, NM)
- **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
- Cognizant (Santa Fe, NM)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... 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 Appeals and… more
- CVS Health (Santa Fe, NM)
- …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
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …The New Mexico VA Health Care System is looking for a Registered Nurse for the Surgical Service Team! Responsibilities The Outpatient Staff Registered Nurse ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Core elements… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …Health Care System is looking for a Maternity Care Coordinator (MCC) Registered Nurse (RN) in the Ambulatory Care Service Team! Responsibilities The Maternity Care ... Coordinator (MCC) Registered Nurse (RN) focus is on individual growth and development...fetal outcomes. Retrieves statistical data on maternity care and utilization at the local VAMC using Veterans Health Administration… more
- Molina Healthcare (Albuquerque, NM)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Molina Healthcare (Las Cruces, NM)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- MTC (Chaparral, NM)
- …performing the duties of the position. + Implement basic cost containment and utilization management for patient care and facility operations. + Maintain ... attendance is required. **Education and Experience Requirements:** + **Advanced Registered Nurse Practitioner:** Graduate of a Master of Nursing program. Successful… more
- Highmark Health (Santa Fe, NM)
- …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
- Evolent (Santa Fe, NM)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- CVS Health (Santa Fe, NM)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the… more
- Fresenius Medical Center (Farmington, NM)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Albuquerque, NM)
- …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
- MTC (Chaparral, NM)
- …the use of appropriate sanitation methods. 6. Practice basic cost containment and utilization management for patient care and facility operations. 7. Maintain ... retirement plan **Make a difference in health care! Operated by the Management & Training Corporation, Otero County Processing Medical Center in Chaparral, New… more
- Fresenius Medical Center (Albuquerque, NM)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Molina Healthcare (Roswell, NM)
- …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
- Community Health Systems (Carlsbad, NM)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... experience required + 3-5 years of experience in care management or utilization review required + 1-3...quality improvement. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Molina Healthcare (Roswell, NM)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more