- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …care insuranceEducation & RequirementsThree (3) or more years of experience in utilization management in a health care delivery setting with knowledge of all ... and regulatory compliance for Prior Authorization process within Utilization Management Out-Patient Services. You lead quality audits, provide clinical oversight,… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …and requirements to ensure coordinated, continuous, cost-effective quality outpatient health care for Members and Providers.7. Ensure Utilization Management ... care insuranceEducation & ExperienceFive (5) or more years of experience in utilization management in a health care delivery setting. Three (3) or more years… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …discussions.9. Collaborates on Member care issues with other Enhanced Care Management Team Members and consults with Nurse Care Manager and/or the ... opportunity to an authentic experience!Under the direct supervision of the Enhanced Care Management Department Leadership, the Community Health Worker - ECM… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …Qualifications: *-Minimum of six (6) years demonstrated experience in a clinical/health care environment with demonstrated experience in at a professional level in ... quality improvement/clinical program oversight/project management .-*Education*: Bachelor's degree in science or health/healthcare related field from an accredited… more
- Commonwealth Care Alliance (Springfield, MA)
- …Care Alliance's (CCA) Care Partner is primarily responsible for providing comprehensive care coordination and care management to CCA members from one ... or more CCA benefit programs. The Care Partner provides care management , and care coordination to a defined panel of CCA members and is the primary… more
- CVS Health (New York, NY)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... ability to innovate and deliver solutions to make health care more personal, convenient and affordable. A Brief Overview...and affordable. A Brief Overview This is a unique hybrid position that will support the an external provider… more
- Bon Secours Mercy Health (Springfield, OH)
- … Nurse with active License in State of Patient Care Licensure/Certification Preferred Case Management certification **Minimum Qualifications** Minimum ... patients. Work directly with the patient, family/support members, inpatient case management team, and interdisciplinary care team members during admission… more
- Kepro (Indianapolis, IN)
- …health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: ... Our Utilization Management Appeals Nurse - LPN/RN will help...Appeals Team, contribute to quality initiatives, and champion continuous care for our members. From meticulous case reviews to… more
- Sharp HealthCare (San Diego, CA)
- …NIH Stroke Scale (NIHSS) - Various-Employee provides certificate; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift ... Professional Nurses Network, United Nurses Associations of California/Union of Health Care Professionals, NUHHCE, AFSME, AFL-CIO. Placement within the range is based… more
- University of Pennsylvania (Philadelphia, PA)
- …resources, and much more. Posted Job Title Developmental Therapeutics Clinical Research Nurse C/D ( Hybrid Eligible)(Abramson Cancer Center) Job Profile Title ... Clinical Research Nurse C Job Description Summary The Abramson Cancer Center...Unit (CRU) is to advance the science of cancer care , serve our patients by improving clinical outcomes, and… more
