- CVS Health (Phoenix, AZ)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Centene Corporation (Jefferson City, MO)
- …be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CDPHP (Latham, NY)
- …care experience in a hospital setting required. + Minimum one (1) year quality/ utilization management experience in health care setting preferred. + Experience ... alternative services to the medical directors. This position is remote with the potential for meetings on-site at CDPHP...with utilization management software including Facets, Macess and… more
- ChenMed (Miami, FL)
- …expanding and we need great people to join our team. The Registered Nurse , Remote Triage, is responsible for providing telephonic triage directional patient ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Providence (OR)
- …+ Dual RN License: Oregon and Washington + 1 year Quality management /quality improvement/ utilization review auditing experience, including experience in auditing ... empower them._** **Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:** + Be responsible for...fill in for staff vacancies. **_Providence Health Plan welcomes remote work for applicants who reside in:_** + Washington… more
- CareFirst (Baltimore, MD)
- …psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Highmark Health (Washington, DC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- CVS Health (Lansing, MI)
- …the case management system to organize cases dealing with disease management and utilization review; tracks patient progress and manages specific conditions. ... providers. Serves as advocate for patients, ensuring effective communication, resource utilization , and continuous monitoring of their progress to promote positive… more
- Actalent (Santa Barbara, CA)
- Remote Utilization Management RN Leading...of those in need is now looking for a REMOTE Health Plan Nurse Coordinator to join their ... heling hand, alpha resource center, parents helping parents, etc. knowledge of Utilization Management process/ turnaround times. + Familiar with mandated… more
- Elevance Health (Washington, DC)
- **Medical Management Nurse ** **Location:** Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and ... a dynamic and adaptable workplace. Alternate locations may be considered. The **Medical Management Nurse ** will be responsible for review of the most complex… more