- Elevance Health (St. Louis, MO)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Blue KC (MO)
- …and state and federal regulations. + Valid and active Registered nurse ( RN ) in Missouri and Kansas. + Case Management Certification within 3 years of ... medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization, issues authorization letters, and... and clinical transplant experience + Valid and active Registered nurse ( RN ) licensure in… more
- Humana (Jefferson City, MO)
- …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Highmark Health (Jefferson City, MO)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
- CVS Health (Jefferson City, MO)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more
- Blue KC (MO)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Medical Policy Nurse Specialist researches, coordinates, analyzes, and ... provides clinical expertise in the application of medical policy and clinical UM guidelines ensuring...+ 5 years of related experience in research, Utilization Management , and medical policy work + Strong… more
- Evolent (Jefferson City, MO)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
- Humana (Jefferson City, MO)
- …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
- Highmark Health (Jefferson City, MO)
- …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
- Elevance Health (St. Louis, MO)
- …The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health and substance use disorder inpatient and ... necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as… more