- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Molina Healthcare (Roswell, NM)
- … RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional ... licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of training… more
- Fresenius Medical Center (Farmington, NM)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Albuquerque, NM)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... leading your business, and advanced leadership. As a Clinical Manager , you may advance your career into an Area...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Fresenius Medical Center (Albuquerque, NM)
- …accounting department. + Acts as the Facility Manager in the absence of the manager or at the direction of management . + Ensure nurses' progress notes are ... Fe, Clovis, and Los Lunas **PURPOSE AND SCOPE:** Works with the Facility Manager , facility staff and physician to coordinate the facility operations and patient… more
- CVS Health (NM)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Community Health Systems (Las Cruces, NM)
- … skills to prioritize tasks in a dynamic environment. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State ... up to a $20,000 Sign-On for eligible Full Time, Registered Nurse candidates! **Why MountainView Regional Medical...are Proud to be MountainView! **Job Summary** The Care Manager - RN is responsible for coordinating… more
- Children's Home Healthcare (Albuquerque, NM)
- …an RN , BSN preferred + Current CPR + At least 2 years experience as a Registered Nurse + At least 1 year experience as a Clinical Supervisor in Home Health ... LICENSE* Children's Home Healthcare is now hiring for a RN Clinical Supervisor/Case Manager ! Children's HH is...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Molina Healthcare (Las Cruces, NM)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Magellan Health Services (Albuquerque, NM)
- …Professional Counselor - Care MgmtCare Mgmt, PC - Professional Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - ... , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management ...required: BCBA, LCSW, LMFT, LMSW, LPCC, LPC, PC or RN . If RN , BSN preferred but ASN… more