- Humana (Richmond, VA)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Richmond, VA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
- Elevance Health (Woodbridge, VA)
- …and adaptable workplace. The office is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the most complex or challenging ... RN Utilization Review Nurse (Washington DC Medicaid)...the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred.… more
- Humana (Richmond, VA)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- HCA Healthcare (Richmond, VA)
- …to join an organization that invests in you as a(an) Case Manager Behavioral Utilization Management ? At Chippenham Hospital, you come first. HCA Healthcare has ... We are looking for a dedicated Case Manager Behavioral Utilization Management like you to be a...of employment start date + Bachelors Degree, or Registered Nurse Diploma + Licensed Clinical Social Worker (LCSW), or… more
- Zurich NA (Richmond, VA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Humana (Big Stone Gap, VA)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Veterans Affairs, Veterans Health Administration (Portsmouth, VA)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... limited to: Patient Aligned Care Team (PACT) Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based gender-specific primary… more
- Evolent (Richmond, VA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Bon Secours Mercy Health (Suffolk, VA)
- …Time/PRN **Summary of Primary Function/General Purpose of Position** The Registered Nurse Medical/Surgical functions as a care provider of a multidisciplinary care ... provision of patient care, demonstrates strong skills related to effective time management and prioritizing patient care, contributes to the provision of quality… more