- 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
- Sanford Health (Bemidji, MN)
- …minimum of five years of clinical practice. Knowledge and experience in case management , utilization management and/or Coding highly preferred. Currently ... Full time **Weekly Hours:** 40.00 **Salary Range:** $31 - $49.50 **Department Details** Remote Work Flexibility: Enjoy the option to work remotely, offering a better… more
- Centene Corporation (Raleigh, NC)
- …**This is remote position. Ideal candidate will have experience in utilization reviews.** **ONCE FULLY TRAINED, THE WORK SCHEDULE WILL BE AS FOLLOWS:** **4 ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- ChenMed (Miami, FL)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- Prime Therapeutics (Phoenix, AZ)
- …and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing ... Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt...experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing… more
- Molina Healthcare (Oakland, CA)
- …Preservice and outpatient experience. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- Centene Corporation (Raleigh, NC)
- …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 + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (Albany, NY)
- …Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources ... cases at case conferences for multidisciplinary focus to benefit overall member management . * Facilitates overall care coordination with the care team to ensure… more
- Ochsner Health (Lafayette, LA)
- …of registered nurse (RN) licensure. Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare Management (CPHM). **Knowledge ... job manages the daily operations of all assigned divisions within the case management department in collaboration with the case management and social services… more
- Humana (Madison, WI)
- …plays a key leadership role in overseeing the daily operations of the Utilization Management and Pre-Authorization nursing teams. This position ensures timely ... delivery and compliance. + Provide daily operational support and guidance to Utilization Management (UM) and Pre-Authorization (PA) nursing staff. + Conduct… more
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