- Molina Healthcare (Long Beach, CA)
- …skills. * Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Registered Nurse ( RN ). License must be active and ... * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or… more
- Prime Healthcare (Chicago, IL)
- …Clinical Manager . Qualifications EDUCATION, EXPERIENCE, TRAINING + Current and valid state Registered Nurse license. + Five (5) years of experience in acute ... Responsibilities Under the direction and supervision of the Clinical Manager , the RN Assessment Coordinator is responsible...hospital setting in a Utilization Review, Case Management, business office or… more
- Dignity Health (Gilbert, AZ)
- …experience. **Licensure:** Active Arizona or Compact state RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM- RN ... skills + Collaborate effectively with multiple stakeholders + Understand how utilization management and case management programs integrate + Ability… more
- Elevance Health (Las Vegas, NV)
- …complex case types that do not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians. Primary duties may include ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- CareFirst (Baltimore, MD)
- …addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... coverage. + Oversees and participates in care coordination activities including case management and disease management to ensure effective transition across levels… more
- Parkview Health (Fort Wayne, IN)
- …off with plan of initial clinical care. Works collaboratively with Point of Entry Case Manager to ensure all patients have verified admission order and status ... recognition program + Ask about our Hotel Program! Qualifications: + Valid Indiana Registered Nurse license required. + Additional certifications may be required… more
- Magellan Health Services (Gallup, NM)
- … - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... clinical path variance data that indicates potential areas for improvement of case and services provided. + Works with members and the interdisciplinary care… more
- Hackensack Meridian Health (Edison, NJ)
- …systems; Google Docs, EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP ... Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures....Certification. **Licenses and Certifications Preferred** : + Certified Case Manager or Accredited Case … more
- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. ... industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans… more
- CVS Health (Harrisburg, PA)
- …actionable opportunities related to CM, gap closure, workflow discussions, and partnering with case manager supervisor/ manager and CMs - Serving as internal ... Operations and others on initiatives for Stars/quality improvement **Required Qualifications** - Registered Nurse with active and unrestricted license in state… more