- Cognizant (Olympia, WA)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Humana (Olympia, WA)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Molina Healthcare (Tacoma, WA)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… more
- CVS Health (Olympia, WA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Centene Corporation (Olympia, WA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Sharecare (Olympia, WA)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Providence (WA)
- …RN License: Oregon and Washington + 1 year Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... Healthcare Effectiveness and Data Information Set (HEDIS) program. Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy… more
- Highmark Health (Olympia, WA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Molina Healthcare (Bellevue, WA)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This… more
- Molina Healthcare (Spokane, WA)
- JOB DESCRIPTION Job Summary The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for verifying ... and critical care experience, ie ER or ICU. Candidates with Utilization Management and med/surge experience are highly preferred. Exceptional time management… more