- Sutter Health (Goleta, CA)
- …& LICENSURE:** + RN-Registered Nurse of California + CCM - Certified Case Manager (certification may be required by entity and time to acquire within 2 years of ... Medicaid Services (GR) Grouper (CMS), Department of Managed Health Care , National Committee for Quality Assurance ( NCQA )....Health Care , National Committee for Quality Assurance ( NCQA ). + A broad knowledge base of outpatient, acute,… more
- Molina Healthcare (Oakland, CA)
- …as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of ... Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA , CMS and State Medicaid requirements including delegation standards and… more
- Sea Mar Community Health Centers (Puyallup, WA)
- …for the following position(s): Sea Mar is a mandatory COVID-19 and flu vaccine organization Nurse Manager - Posting #26096 Nurse Manager RN Annual ... Manager LPN Annual Salary: $74,958.09 Position Summary: Full-time Nurse Manager position available for our Medical...other support staff + Oversee and maintain a patient care system of nurse only visits. +… more
- Sea Mar Community Health Centers (Tacoma, WA)
- …the following position: Sea Mar is a mandatory COVID-19 and flu vaccine organization Nurse Manager - Posting #25738 Salary Rate: $74,958.09 (LPN) - $92,444.35 ... (RN) Position Summary: Full-time Nurse Manager (RN or LPN) position available...technics, etc ) + Oversee and maintain a patient care system for nurse visits. + Employ… more
- Sea Mar Community Health Centers (Aberdeen, WA)
- …for the following position(s): Sea Mar is a mandatory COVID-19 and flu vaccine organization Nurse Manager (RN or LPN) - Posting #27454 Hourly Rate: $36.04 - ... $74,958.09 - 92,444.35 (depending on license/experience) Position Summary: Full-time Nurse Manager position available for our Aberdeen...other support staff. + Oversee and maintain a patient care system of nurse only visits. Requirements:… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Plan Solutions (BHPS) provides Case Management services to its clients. Cases are maintained by the Nurse Case manager . The Nurse Case Manager reports to ... Word, Office, Excel, and working in a database environment. * Familiarity with URAC/ NCQA standards, Milliman Care Guidelines (MCG) experience preferred. * Bonus:… more
- LA Care Health Plan (Los Angeles, CA)
- …communication skills. Preferred: Knowledge of National Committee for Quality Assurance ( NCQA ) requirements for Utilization Management or Care Management (CM). ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department:...$115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). ... which may include but is not limited to ERISA, NCQA , URAC, DOI (State), and DOL (Federal). + Provides...determine medical necessity criteria and contract benefits. Collaborates with Care Management and other areas to ensure proper … more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan.… more