- Humana (Madison, WI)
- …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Molina Healthcare (WI)
- 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 ... promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Madison, WI)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **_Wisconsin RN license required_** JOB DESCRIPTION Job SummaryProvides support...promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications… more
- Molina Healthcare (Kenosha, WI)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2… more
- Centene Corporation (Madison, WI)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM … more
- Evolent (Madison, WI)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the ** RN /LVN/LPN** scope of practice, under the Medical ...InterQual) + Minimum of one year of experience with medical management activities in a managed care… more
- Humana (Madison, WI)
- …the design, implementation, and advancement of strategic initiatives within the Utilization Management ( UM ) function. This role is responsible for leveraging ... or program management . + Advanced degree or professional certification (eg, RN , LPN, MBA, PMP, ASA/FSA). + Experience with designing and implementing clinical… more
- Lakeview NeuroRehabilitation Center (Waterford, WI)
- …deadlines. Able to work with staff, patients, and families of varied backgrounds. + Education: Registered Nurse , ADN or BSN. + Licensure: Current WI RN ... The Scope of Practice for the RN Case Manager includes responsibility for management...the Lead Case Manager, the MD Chair of the UM committee, the Medical Social Worker, and… more
- Highmark Health (Madison, WI)
- …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more