- CVS Health (Denver, CO)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in CST and MST zones.… more
- Humana (Denver, CO)
- …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 (Denver, CO)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require...one, (1), year of experience auditing and/or performing case management or utilization management chart… more
- Baylor Scott & White Health (Denver, CO)
- **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
- Evolent (Denver, CO)
- …Doing:** 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
- CVS Health (Denver, CO)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Pharmacy or Medical Surgical** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… 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 ... 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
- 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
- Humana (Denver, CO)
- …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
- UCHealth (Aurora, CO)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... Description Location: UCHealth UCHlth Anschutz Inpt Pavilion, US:CO:Aurora Department: UCHA Care Management FTE: Full Time, 1.0, 80.00 hours per pay period (2 weeks)… more
- Elevance Health (Denver, CO)
- …required. **Preferred Capabilities, Skills and Experiences:** + Previous experience in case management / utilization management with a broad range of ... a related behavioral health field or a degree in nursing , and minimum of 3 years of experience with...experience preferred. + Inpatient psychiatric hospital experience preferred. + Utilization review management experience preferred. + Strong… 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
- The Cigna Group (Denver, CO)
- …to Health Services, Care Management , and Health / Wellness programs (eg, utilization management , case management , demand management , medical review, ... NP) + Advanced education / certification in clinical informatics, nursing informatics, clinical data management If you will be working at home occasionally or… 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
- University of Colorado (Aurora, CO)
- …+ Participate in the development of lab stewardship tools, data analysis and utilization management strategies in the UCH Clinical laboratory. This role will ... work:** **Employment Expectations:** + Participate in the clinical care, administrative management , teaching and research missions of the UCH Clinical Laboratory and… more