- Centene Corporation (New York, NY)
- … Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to… more
- AmeriHealth Caritas (Lafayette, LA)
- …ability to meet productivity standards in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse (RN) license ... will also be counted upon to: **Work Arrangement:** + Remote role requiring residency in Louisiana. + Availability to...organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems (eg, JIVA) to efficiently… more
- Access Dubuque (Dubuque, IA)
- …reviewing the group specific requirements and will also triage the call to determine if a Utilization Review Nurse is needed to complete the call. You will ... The Utilization Management Assistant answers first level calls in Utilization Review for HealthCheck360 participants. They will evaluate certification… more
- Humana (Lincoln, NE)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... 3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department...ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency in MS… more
- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** ... strong inpatient acute care bedside nursing experience** + **Brings a background in Utilization Management/ Review ** + **Holds an active nursing license** + **Is… more
- Molina Healthcare (Salt Lake City, UT)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… more
- Sharecare (Helena, MT)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Providence (WA)
- …RN License: Oregon and Washington + 1 year Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... Healthcare Effectiveness and Data Information Set (HEDIS) program. Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy… more