- Spira Care, LLC (Kansas City, KS)
- …Minimum Qualifications + Associate or bachelor's degree in nursing + Valid and active Registered Nurse ( RN ) in Kansas and Missouri or multi-state compact ... include: + Highly competitive total rewards package, including comprehensive medical , dental and vision benefits as well as a...helping people achieve their health goals. The Care Guide, RN is an integral role within the Care Team… more
- Molina Healthcare (Spokane, WA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Molina Healthcare (San Diego, CA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** * At least… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …(ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, Geriatrics, etc.) to ... consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and… more
- Actalent (Atlanta, GA)
- …Service, Claims, Contracts and Benefits - Appeals, and Risk Management . Essential Skills + Registered Nurse ( RN ) with a valid license in GA or Compact. + ... REMOTE Job Description This role involves performing precertification and medical necessity reviews for designated referrals and targeted outpatient...1+ years of experience in Utilization Management ( UM ). + 1+ years of experience… more
- Molina Healthcare (Dayton, OH)
- …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
- Molina Healthcare (CA)
- …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
- Molina Healthcare (North Las Vegas, NV)
- …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
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review, obtains case or disease management support, or otherwise ... coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and… more
- Whidbey General Hospital (Coupeville, WA)
- …etc. The RN - Care Manager follows the hospital's Case Management /Utilization Plan that integrates the functions of utilization review, discharge planning, and ... management either during admission or post discharge. The RN - Care Manager acts as a resource to...Patient Access, Patient Financial Services (PFS) and Health Information Management (HIM), as appropriate. + Escalates Medical … more