- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by State law **(Required)** + Three ... our Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator - Inpatient RN ** performs reviews of admissions and concurrent stay requests for… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + ... . The **Care Coordinator** - **Clinical Appeals** performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …preauthorization, outpatient and inpatient management, case management, retrospective claim review , and delegated management oversight. + Participate in the ... the adjustment and direction of work processes to support cost and utilization variations. + Participate in the development, implementation, and monitoring of the… more
- Swedish Health Services (Seattle, WA)
- **Description** ** Utilization Review RN @...an accredited school of nursing. + Upon hire: Washington Registered Nurse License + 3 years ... you the chance to focus on what really matters - our patients.** The Utilization Review (UR) Nurse has a strong clinical background blended with a… more
- Molina Healthcare (Bellevue, WA)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
- Molina Healthcare (Bellevue, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Bellevue, WA)
- …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
- CenterWell (Kent, WA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Bellevue, WA)
- …claims review , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The RN Lead, DRG Coding/Validation provides lead level support...* Performs clinical reviews of medical records and other utilization management documentation to evaluate issues of coding and… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …(2) years of acute hospital clinical experience + Current licensure as a Registered Nurse in the state of Washington ( RN -WA) + BLS required within 3 months ... the way our patient care is delivered. As a Registered Nurse at Virginia Mason you are...+ Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used We deliver inspired… more
- Battelle Memorial Institute (Tacoma, WA)
- …two years' nursing experience + Current, full, active, and unrestricted license as a Registered Nurse in any US State, the District of Columbia, Guam, Puerto ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report… more
- University of Washington (Seattle, WA)
- …to support successful testimony in ITA court + Attend treatment team, utilization review , quality improvement and other meetings as requested/required. Attend ... Degree as required by specialty + Licensed as a psychologist, advanced registered nurse practitioner, mental health counselor or independent clinical social… more
- Molina Healthcare (Tacoma, WA)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Tacoma, WA)
- …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 Care Review Clinician RN provides support for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Bellevue, WA)
- …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...member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm… more
- Molina Healthcare (Bellevue, WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Swedish Health Services (Seattle, WA)
- …beyond three years is contingent upon attaining the BSN degree + Upon hire: Washington Registered Nurse License + 3 years Registered nursing experience in an ... **Description** **Care Manager RN - Emergency Department @ Swedish First Hill**...focus on what really matters - our patients.** The nurse case manager coordinates the care and service of… more
- Pacific Medical Centers (Renton, WA)
- …+ Coursework/Training Nursing (must be RN ) And + Upon hire: Washington Registered Nurse License + 5 years Clinical experience **Preferred Qualifications:** + ... **Description** The Supervisor Care Management RN is responsible for the supervision of case...responsible for the supervision of case management (CM) and utilization management (UM) functions of US Family Health Plan… more
- LifeCenter Northwest (Bellevue, WA)
- …availability, evening, and weekend work. EDUCATION, EXPERIENCE & JOB REQUIREMENTS + Registered Nurse , Physician's Assistant, or other relevant health care ... donor management protocols aimed at optimizing organ function and increasing organ utilization . + Routinely reviews performance metrics and recommends changes in… more
- Elevance Health (Seattle, WA)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... time,** **with rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of… more
