- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- Centene Corporation (Harrisburg, PA)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... including a fresh perspective on workplace flexibility. **THIS POSITION IS REMOTE /WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS MEDICAID CHIP PROGRAM.**… more
- Actalent (Santa Barbara, CA)
- … Nurse assigned to various Health Services operational units. These units include Utilization Management , Case Management , Enhanced Care Management , ... Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse...Model, and Population Health programs. The role involves performing utilization management activities, including telephonic or onsite… more
- Centene Corporation (Austin, TX)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations),… more
- Molina Healthcare (NE)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Molina Healthcare (TX)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- ChenMed (St. Louis, MO)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Highmark Health (Harrisburg, PA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Actalent (Austin, TX)
- …member care decisions + Document review findings, discharge plans, and actions in health management systems per utilization management policies + Work with ... Clinical Review Nurse - Concurrent Review Location: Remote ...Trucare Cloud preferred) + Knowledge of Medicaid regulations and utilization management processes preferred + Proficiency in… more