- Commonwealth Care Alliance (Springfield, MA)
- … experience in primary care or care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + ... and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an...and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the … more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB, ... accordance with References (e) and (o). After following the directed methodology for appeals , the MTF will also adhere to its respective Service or joint commands'… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... at 5:00 pm on: 5/8/2025, 7/3/2025, 9/4/2025, 11/6/2025 Registered Nurse D/CF Level I: $61.27 - $74.48 hourly Registered...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 7/3/2025, 10/3/2025 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- St. Luke's University Health Network (Allentown, PA)
- …+ Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC ... appeals for complex case reviews for medical necessity, including...EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state… more
- State of Colorado (Denver, CO)
- Registered Nurse Complaints Health Compliance Inspector - FAA00731 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5058918) Apply ... Registered Nurse Complaints Health Compliance Inspector - FAA00731 (HP III...software applications, and communicating through email is required. + Non- clinical or clinical health care experience, preferably… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position is On-Site The Behavioral Health Nurse - Managed Care is responsible for coordinating, monitoring, and delivering behavioral health services within a ... community resources. + Authorize services and coordinate referrals based on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.8 FTE (8 ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Prime Therapeutics (Atlanta, GA)
- …and enters data of these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings ... work visa or residency sponsorship **Additional Qualifications** + Registered Nurse (RN). + 5 years of post-degree clinical... Nurse (RN). + 5 years of post-degree clinical experience. + Experience in managed care, specialty drugs,… more
- State of Colorado (Denver, CO)
- Registered Nurse Health Compliance Inspector, Nursing Facilities - FAA00867 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5075443) ... Apply Registered Nurse Health Compliance Inspector, Nursing Facilities - FAA00867 (HP...software applications, and communicating through email is required. + Non- clinical or clinical health care experience, preferably… more