- Parexel (Santa Fe, NM)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- CVS Health (Santa Fe, NM)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (Santa Fe, NM)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Santa Fe, NM)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- Community Health Systems (Carlsbad, NM)
- …Commitment to patient-centered care and continuous quality improvement. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... + Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable… 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 ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… 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
- Molina Healthcare (Albuquerque, NM)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Molina Healthcare (Santa Fe, NM)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… 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
- 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. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Molina Healthcare (Santa Fe, NM)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical...member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday… more
- Children's Home Healthcare (Albuquerque, NM)
- …an RN , BSN preferred + Current CPR + At least 2 years experience as a Registered Nurse + At least 1 year experience as a Clinical Supervisor in Home Health ... * RN LICENSE REQUIRED, DO NOT APPLY IF YOU...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …Mexico VA 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...fetal outcomes. Retrieves statistical data on maternity care and utilization at the local VAMC using Veterans Health Administration… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- … Nurse for the Surgical Service Team! Responsibilities The Outpatient Staff Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care....level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Healthfirst (NM)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, ... case management as assigned. The Case Manager, Utilization Management is also responsible for efficient...necessary + Additional duties as assigned Minimum Qualifications: + RN , LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or… more
- Molina Healthcare (NM)
- …attitude for success **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). RN licensure ... multidisciplinary teams to promote Molina care model. * Adheres to utilization management (UM) policies and procedures. * May work collaboratively with… more
