- Centene Corporation (Austin, TX)
- …and provide recommendations to senior management of process improvements within utilization management + Manages and oversees cases to ensure timely ... to the interdepartmental teams on training needed within the utilization management team based on trends +... processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + For Health Net… more
- Actalent (Tigard, OR)
- …at least 2 years in acute care. + Strong skills in clinical review, utilization management , and concurrent review. + Self-starter with excellent time ... of Medicare and Medicaid regulations. + Preferred understanding of utilization management processes. Work Environment This is...management processes. Work Environment This is a 100% remote position based on the West Coast, with working… more
- Humana (Tallahassee, FL)
- …action. + Live in NC, SC, FL or GA + 2 or more years of Utilization Management (UM), Pre-Auth, and/or other managed care review experience + 1 or more ... internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. + Enters and maintains pertinent… more
- Medical Mutual of Ohio (OH)
- …care at the most appropriate time. + Keeps up to date on utilization management regulations, policies and practices, including applicable coding. + Performs ... degree preferred. + 3 years experience as a Registered Nurse in acute care, critical care, emergency medical or...or medical surgical or a combination of clinical and utilization /case management experience in the health insurance… more
- Banner Health (Gilbert, AZ)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the ... electronic surveillance partnership in caring for the patient, where remote nurses have the ability to interact with patients...completion of a bachelor's degree in case management or health care. Requires current Registered … more
- Trinity Health (Mishawaka, IN)
- …is NOT a remote position.** **_About the job:_** The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in ... & Stewardship:** Incorporates caring process (Caritas), advocacy & appropriate resource utilization as an essential component of nursing practice through concrete… more
- Humana (Springfield, IL)
- …Care Coordinators and other identified care team members as needed along with utilization management (UM) staff, physicians and providers as necessary and ... health first** Humana Gold Plus Integrated is seeking a RN, Care Manager, Telephonic Nurse 2 who will assess and evaluate member's needs with emphasis on discharge… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- InGenesis (Columbia, SC)
- …guidelines. In this role, you will provide support and review of medical claims and utilization practices. This is a REMOTE opportunity for a LPN living in the ... InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our...operations of assigned area. * Interfaces with the medical management on a regular basis to work more complex… more
- Ochsner Health (Baton Rouge, LA)
- …Health and discover your future today!** This job works with organizational management to implement and maintain a nationally recognized Diabetes Self- Management ... subject to change at the company's discretion. **Education** Required - Registered nurse diploma or bachelor's degree in related field Preferred - Master's degree… more