- Magellan Health Services (Newtown, PA)
- …Counselor - Care MgmtCare Mgmt, LSW - Licensed Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN . Minimum 2 years experience post degree in healthcare,...time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
- Molina Healthcare (Warren, MI)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum ... members of the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care reimbursement. Working… more
- Sharp HealthCare (San Diego, CA)
- …Time** **Shift End Time** Bachelor's Degree in Nursing; Bachelor's Degree; Master's Degree; California Registered Nurse ( RN ) - CA Board of Registered ... Or + Bachelor's Degree in Healthcare Administration. + California Registered Nurse ( RN ) - CA...and Health Services to ensure timely submission of required Utilization , Case Management and Disease Management… more
- Molina Healthcare (MI)
- …state board licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of ... or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care… more
- Humana (Tallahassee, FL)
- …Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The ... and identified medical metrics (ex. HEDIS, APT, readmissions, ED utilization , polypharmacy, etc.). In this role, you will actively...skills to make an impact** **Required Qualifications** + FL RN License + Must reside in the state of… more
- CVS Health (Columbus, OH)
- …of Appeals experience in Utilization Management + 3+ years utilization review experience. **Education** + Associate degree RN required + BSN preferred ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...internal and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted… more
- Somatus (Utica, NY)
- …utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management ... telephonically as the need arises. **This is a fully remote role where New York licensure is required.** **The...Uses protocols and pathways in line with established disease management and care management programs and approved… more
- Somatus (Mclean, VA)
- …utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management ... telephonically as the need arises. **This is a fully remote role where compact licensure is strongly preferred.** **The...Uses protocols and pathways in line with established disease management and care management programs and approved… more
- Ochsner Health (Slidell, LA)
- …surgery clinic, clinical research or medical records. **Certifications** Required - Current RN License in the state of practice **Knowledge Skills and Abilities ... operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems. + Responsible for the accurate… more