- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... quality of medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and over- utilization … more
- Zurich NA (Jefferson City, MO)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...more years of experience in the Nursing areaAND + Registered Professional Nurse license in residential area… more
- Centene Corporation (Jefferson City, MO)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... YEAR WITH THIS ROLE **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact… more
- HCA Healthcare (Kansas City, MO)
- …quality care in the most compassionate way. A Diagnostic Imaging Registered Nurse provides patient care through utilization of the nursing process. Unlock ... path, we encourage you to apply for our Registered Nurse RN Radiology opening. We review all applications. Qualified candidates will be contacted by a member… more
- CVS Health (Jefferson City, MO)
- …care. - Perform medical necessity reviews. **Required Qualifications** - 5+ years' experience as a Registered Nurse (RN) with at least 1 year of experience in a ... hospital setting. - A Registered Nurse that holds an active, unrestricted...lower levels of care. - 1+ years' experience in Utilization Review . - CCM and/or other URAC… more
- CVS Health (Jefferson City, MO)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse (RN) with at least 1 year of experience in a ... hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Sharecare (Jefferson City, MO)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- ChenMed (St. Louis, MO)
- … and discharge planning. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of Utilization Review (UR) and discharge planning + Strong interpersonal and ... a related clinical field preferred + A valid, active Registered Nurse (RN) license in State of...experience required + A minimum of 1 year of utilization review and/or case management, home health,… more
- Lincoln Financial (Jefferson City, MO)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Centene Corporation (Jefferson City, MO)
- …required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required or + LCSW- ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more