- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Richmond, VA)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... 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 … more
- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Evolent (Richmond, VA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …observation experiences throughout the program. The educators, along with preceptor and Nurse Directors, assess each participant's clinical progression to match ... and partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate,… more
- Fresenius Medical Center (Louisa, VA)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Elevance Health (Richmond, VA)
- **Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience;… more
- CVS Health (Richmond, VA)
- …leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Fully Integrated Dual ... has an understanding on how to take their ordered medications. + Providing clinical assistance to determine appropriate services and supports due to member's health… more
- ChenMed (Virginia Beach, VA)
- …position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent ... of practice + A minimum of 3 years experience working in Cardiology as a Nurse Practitioner in an out-patient clinical setting + Basic Life Support (BLS)… more
- ChenMed (Norfolk, VA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to ... may be required based on State of practice + Minimum 2 years of clinical experience as a Nurse Practitioner required practicing in Family Medicine, Internal… more
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