- Humana (Jackson, MS)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Qualifications** + Bachelor's Degree (BSN) + Utilization management experience is highly preferred + Health ...Medicare experience a plus + Milliman MCG experience preferred **Work-At- Home Requirements** To ensure Home or Hybrid… more
- CenterWell (Jackson, MS)
- …practice in a related specialty such as home infusion or specialty infusion, home health , oncology, IV therapy or critical care + Minimum 5 years nursing ... the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care...such as home infusion or specialty infusion, home health , oncology, IV therapy or critical… more
- Evolent Health (Jackson, MS)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes..., you will be a key member of the utilization management team. We can offer you… more
- CenterWell (Jackson, MS)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Evolent Health (Jackson, MS)
- …Be Doing:** As a Physician Clinical Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- Marriott (Jackson, MS)
- …and Vocational Rehabilitation for injured workers per regional guidelines. + Oversee Home Health and Field Case Managers. **Claims Services** + Collaborate ... to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health resources. Quality, cost...with Claims department regarding case management . + Collaborate with UNM on utilization … more
- CVS Health (Jackson, MS)
- Bring your heart to CVS Health . Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health . This purpose ... guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in...typically limited to a 50 mile radius of employee's home . Hours for this position are Monday-Friday 8a-5p CST.… more
- Sharecare, Inc. (Jackson, MS)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more