- University of New Mexico - Hospitals (Albuquerque, NM)
- …to experience, education, and other business and organizational considerations.Department: Utilization Management - UHFTE: 1.00Full TimeShift: DaysPosition ... appropriate patients within designated specialty area requiring patient case management interventions by utilizing established procedures including census review,… more
- CenterWell (Santa Fe, NM)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Santa Fe, NM)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Santa Fe, NM)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Molina Healthcare (Albuquerque, NM)
- …key health care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. ... professionals, in some or all of the following functions: utilization management , care management , care...and experience. * At least 5 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …Service is seeking qualified applicants to join our team! Responsibilities The Registered Nurse (RN) is responsible and accountable for all elements of the nursing ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers… more
- Molina Healthcare (Las Cruces, NM)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- MTC (Chaparral, NM)
- …performing the duties of the position. + Implement basic cost containment and utilization management for patient care and facility operations. + Maintain ... attendance is required. **Education and Experience Requirements:** + **Advanced Registered Nurse Practitioner:** Graduate of a Master of Nursing program. Successful… more
- Evolent (Santa Fe, NM)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Evolent (Santa Fe, NM)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
