- Humana (Montpelier, VT)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Montpelier, VT)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Montpelier, VT)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Montpelier, VT)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Montpelier, VT)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- Sharecare (Montpelier, VT)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Dartmouth Health (Lebanon, NH)
- …Objective * The Case Manager will spend time specific to the role of case management and utilization review: * Lead a collaborative process with the members of ... nursing required; Master's preferred. * Licensed as a Registered Nurse in the State of New Hampshire. * BCLS...30 days of hire. * Board Certification in Case Management (CCM or CMC) preferred. If not certified, willingness… more
- CVS Health (Montpelier, VT)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Highmark Health (Montpelier, VT)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Dartmouth Health (Lebanon, NH)
- …based in Lebanon NH Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces care standards ... and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources. Responsibilities * Facilitates the development of a plan of… more
- Dartmouth Health (Lebanon, NH)
- …a Per Diem Float position Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces care standards ... and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources Responsibilities 1. Facilitates the development of a plan of… more
- Evolent (Montpelier, VT)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- Datavant (Montpelier, VT)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- Highmark Health (Montpelier, VT)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Dartmouth Health (Lebanon, NH)
- …education experience with previous administration or directorial experience. Previous management experience in an emergency department (ED) environment. * Experience ... * LICENSE/CERTIFICATIONS/REGISTRATIONS SKILLS (Tracked at the department level) Licensed Registered Nurse with NH eligibility * ACLS required * Position Physical… more