- Elevance Health (Denver, CO)
- …in an ambulatory or hospital setting or a minimum of 1 year of prior utilization management , medical management and/or quality management , and/or call ... required. **Preferred Skills, Capabilities, and Experiences** : + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Elevance Health (Denver, CO)
- **Medical Management Nurse ** **Work schedule: M-F 11am-8pm PST.** **Location** : This role enables associates to work virtually full-time, with the exception of ... accommodation is granted as required by law._** The **Medical Management Nurse ** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- CVS Health (Denver, CO)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... or Specialty Pharmacy Advocacy** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- University of Colorado (Denver, CO)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , value-based performance team, emergency department, acute, ... the interdisciplinary approach to providing continuity of care, including utilization management , value-based care, transfer coordination, discharge planning,… more
- Highmark Health (Denver, CO)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... the home state license is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS** + Working knowledge of… more
- Highmark Health (Denver, CO)
- …Health **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
- Highmark Health (Denver, CO)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and… more
- Sharecare (Denver, CO)
- …/ 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
- Elevance Health (Denver, CO)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Denver, CO)
- …care The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements**… more
- Elevance Health (Denver, CO)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager I** **Location: Virtual: This role... Case Manager I** is responsible for performing care management within the scope of licensure for members with… more
- CommonSpirit Health Mountain Region (Lakewood, CO)
- …discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical ... leaders who care about your success. As a Registered Nurse , RN Case Manager you'll advocate for patients while...Applicable State of Employment required + 1 year of nursing or case management experience required. +… more
- Summit Medical Consultants LLC (Denver, CO)
- …and actively participates in medical staff duties. Participates in quality assurance, utilization management , and peer review programs to ensure high quality, ... between Facilities Patient Volume: 15 Per day Immediate opportunity for Nurse Practitioners with Adult/Geriatric experience. ABOUT SUMMIT MEDICAL CONSULTANTS Summit… more
- Summit Medical Consultants LLC (Denver, CO)
- …and actively participate in medical staff duties. Participate in quality assurance, utilization management , and peer review programs to ensure high quality, ... between Facilities Patient Volume: 15 Per day Immediate opportunity for Nurse Practitioners with Adult/Geriatric experience. ABOUT SUMMIT MEDICAL CONSULTANTS Summit… more
- CommonSpirit Health Mountain Region (Lakewood, CO)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing , physicians, ancillary departments, insurers ... (2) years of acute hospital clinical experience or a Master's degree in Case Management or Nursing field in lieu of acute experience. + At least five years of… more
- CommonSpirit Health Mountain Region (Lakewood, CO)
- …discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical ... License in Applicable State of Employment required + 1 year of nursing or case management experience required. + Experience working with EMR preferred. + Working… more
- Summit Medical Consultants LLC (Denver, CO)
- …and actively participates in medical staff duties. Participates in quality assurance, utilization management , and peer review programs to ensure high quality, ... families with robust clinical services throughout their Acute Inpatient Rehab, Skilled Nursing , Long Term Care and Assisted and Independent Living stays. We… more
- Sharecare (Denver, CO)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...every 4th Saturday from 8am-4:30pm CT _ A compact nursing license is required for this position_ **Essential Job… more
- Sedgwick (Denver, CO)
- …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
- HCA Healthcare (Denver, CO)
- …Center have the opportunity to make a real impact. As an Operating Room Registered Nurse PT you can be a part of change. **Benefits** Rose Surgical Center, offers a ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...and professional goals. Help to advance the practice of nursing and improve positive outcomes for your patients as… more