- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ..... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- Cognizant (Oklahoma City, OK)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Humana (Oklahoma City, OK)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Oklahoma City, OK)
- …rotating weekend and holiday schedules. **Preferred** **Qualifications** : + Managed care/ utilization review experience preferred + Experience in a behavioral ... skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You'll apply critical thinking and evidence-based… more
- CVS Health (Oklahoma City, OK)
- …with behavioral health background. **Preferred Qualifications** + 3 years Managed care/ utilization review experience preferred. + Crisis intervention skills and ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt… more
- Veterans Affairs, Veterans Health Administration (Muskogee, OK)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... Veterans Act of 2016. Responsibilities The Community Care (CC) Coordinator Registered Nurse (RN) is responsible for executing a streamlined approach to receiving,… more
- Humana (Oklahoma City, OK)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments… more
- CVS Health (Oklahoma City, OK)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Sharecare (Oklahoma City, OK)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
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