- US Tech Solutions (Columbia, SC)
- …will be conducted. + Onsite training for the first 1-2 weeks remote position after training Monday through Friday, 8:30am-5:00pm. **Responsibilities:** + Reviews and ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …assignments, difficult members and highly visible issues. + Understanding of the basic Utilization Management and Case Management aspects of the department ... and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks...and required. + Performs other functions as assigned by management . Minimum Qualifications: + RN with valid and current… more
- CVS Health (Toms River, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... all with heart, each and every day. **Position Summary** This is a fulltime ** remote /FIELD Based** opportunity with 50 to 75% travel in Ocean County and surrounding… 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. ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Magellan Health Services (San Diego, CA)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or… more
- Providence (OR)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... are terminal and nearing end of life + Care management services include: nurse education, care coordination...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
- Centene Corporation (Columbia, SC)
- …experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred. ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Magellan Health Services (Boise, ID)
- …the management , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care ... management staff, providing expertise in designated programs. + Assists clinical management in the development and on-going management of designated staff. +… more
- GE Vernova (Wilmington, NC)
- … management advised of project progress, performance, and resource utilization with particular attention to delays, adverse trends, errors and omissions ... This role will facilitate cross functional interactions between engineering, project management , and product line organizations. They will coordinate timely decision… more
- Trinity Health (Livonia, MI)
- …Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position At the direction of the Regional Manager, Clinical Documentation ... as it relates to reimbursement and other clinical data quality management for colleague training. Provides quality and productivity monitoring; coordinates and… more