- Guardian Life (Bethlehem, PA)
- As the **Clinical Specialist II, LPN /LVN** you will be a licensed Practical or Vocational Nurse who is knowledgeable in a variety of medical and ... You may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to facilitate… more
- Guardian Life (Bethlehem, PA)
- As the **Clinical Specialist LPN /RN, Disability Claims** you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to… more
- Medtronic (MN)
- …+ 3 year's experience in case management, prior authorization or utilization review + Professional license or credentials (MA, LPN , RN) with clinical nursing ... experience preferred + Understanding of healthcare payment processes, reimbursement and coverage issues including medical necessity, denials, and appeals processes. + Familiar with Medtronic reimbursement policies and procedures. + Excellent written and verbal… more
- Covenant Health Inc. (Knoxville, TN)
- …and as employee turnover occurs. + Participates with clinical, financial and utilization review departments to address opportunities to improve overall ... or GED. Minimum Experience: Experience in outpatient registration. Will consider LPN with two years' experience or individuals with inpatient pre-certification and… more
- Guthrie (Corning, NY)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... collection, data analysis and process outcome evaluation. Education, License & Cert: Licensed Registered Nurse . Bachelor's Degree in Nursing or related field… more
- Centene Corporation (Tallahassee, FL)
- …in eastern or central time zones. Ideal candidate will have experience in utilization review and 1+ years of auditing.** **Education/Experience:** Associate's or ... or healthcare setting. Amisys and CCMS experience preferred. **License/Certification:** RN or LPN license. Pay Range: $55,100.00 - $99,000.00 per year Centene offers… more
- Intermountain Health (Denver, CO)
- …patients and/or patient's family, caregivers, and/or legal representatives socio-economic review and screening to support coordination of care. Plans interventions ... team to provide care coordination for preventative care and utilization mitigation. Identifies appropriate resources, including transportation, housing, healthcare,… more
- Banner Health (Susanville, CA)
- …personalized medical approach and specialize in, general surgeries and orthopedics. **As a Licensed Vocational Nurse , LVN, at Banner Lassen Health Center, you ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable...Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the… more
- Actalent (Eugene, OR)
- …and standards. Essential Skills + Clinical review experience + Prior authorization expertise + Licensed Practical Nurse ( LPN ) or Registered Nurse ... Job Title: Clinical Review Nurse - Prior AuthorizationJob Description...+ Provide education to providers and interdepartmental teams on utilization processes to encourage high-quality and cost-effective care. +… more
- Centene Corporation (Little Rock, AR)
- …of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required and + For ... on workplace flexibility. **Position Purpose:** Drafts correspondence letters based on review outcomes in accordance with National Committee for Quality Assurance… more