- Humana (Salem, OR)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (Salem, OR)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- CareOregon (Portland, OR)
- …+ Minimum 5 years' nursing experience, including at least 2 years in utilization management and/or case management Preferred + Minimum 2 years' ... of CareOregon's Aspiring Leaders Program + Bachelor's degree in Nursing or Masters degree in health related field +... Utilization Management (CPUM), Health Care Management (CPHM), Managed Care Nurse (CMCN) or… more
- PeaceHealth (Springfield, OR)
- …experience may be considered. + Preferred: Utilization management /quality management experience. Credentials + Required: Registered Nurse in state of ... Clinical nursing experience in an acute care hospital. + Required: Equivalent skilled nursing facility, outpatient case management , home health or hospice… more
- CenterWell (Salem, OR)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Salem, OR)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Evolent (Salem, OR)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Humana (Salem, OR)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (Salem, OR)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Salem, OR)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- CareOregon (Portland, OR)
- …Level Manager Direct Reports Registered Nurse - Clinical Quality Assurance, Registered Nurse - Utilization Management II Manager Title Director, Quality ... oversight in the correct and effective use of decision tools used for utilization management activities including staff training. The position is responsible for… more
- Humana (Salem, OR)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Salem, OR)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Columbia Memorial Hospital (Astoria, OR)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... preferred. Education and/or Experience Graduate of an accredited school of nursing ,. Recent Inpatient Care Management experience preferred. Physical Demands… more
- Praxis Health (Eugene, OR)
- …Suite(Word, Outlook, Teams, Excel). + Expertise in chronic disease management , case management , utilization management , and adult acute care. + Hands-on ... Job Description Join Our Team as a Transitional Care Management (TCM) Coordinator! Location:Remote (Oregon residents only) Schedule:Full-time, Monday - Friday… more
- Sedgwick (Salem, OR)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more
- Lincoln County (Newport, OR)
- …mental health nursing duties, which includes direct patient care and nursing case management . This position also promotes physical and emotional health, ... Community Mental Health Nurse Print (https://www.governmentjobs.com/careers/lincoln/jobs/newprint/4944323) Apply Community Mental Health Nurse Salary $38.79 -… more
- Catholic Health Initiatives (Pendleton, OR)
- **Responsibilities** **Relocation Assistance Available!** **Job Summary** The Registered Nurse provides leadership and co-ordination to the health care team to ... needs, based on analysis of assessment data, standards of nursing care and practice. + Collaborates with patient, primary...and scope of practice. + Is aware and demonstrates utilization of proper infection control standards and practices. +… more
- Sharecare (Salem, OR)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse...Hours are on Central Standard Time. _ A compact nursing license is required for this position_ **Essential Job… more
- Fresenius Medical Center (Lebanon, OR)
- …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:… more