• RN Utilization Management…

    Elevance Health (Morgantown, WV)
    RN Utilization Management / Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West ... Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review ) is...an equivalent background. + Current active, valid and unrestricted RN license to practice as a health professional within… more
    Elevance Health (06/11/25)
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  • Clinical Registered Nurse - Remote

    Sharecare (Charleston, WV)
    …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
    Sharecare (05/10/25)
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  • Case Manager Registered Nurse…

    CVS Health (Charleston, WV)
    …2+ years CM, discharge planning and/or home health care coordination experience * Registered Nurse with active unrestricted state license in good standing within ... Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning,… more
    CVS Health (06/06/25)
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  • Registered Nurse - 6A ( Inpatient…

    Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
    … review of the EDRP application Responsibilities Inpatient Mental Health (MH) Registered Nurse ( RN ) provides competent, evidence-based care, the ... nurse independently provides patient-centered and recovery-oriented care, milieu management , and maintains self-awareness while caring for patients living with… more
    Veterans Affairs, Veterans Health Administration (06/13/25)
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  • Care Manager RN - (Remote)

    Highmark Health (Charleston, WV)
    …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
    Highmark Health (06/06/25)
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  • Manager, Utilization Management

    Healthfirst (WV)
    **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review , ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
    Healthfirst (06/11/25)
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  • Consultant, Nurse Disability

    Lincoln Financial (Charleston, WV)
    …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like ... will provide coaching and guidance to claims regarding medical management **What you'll be doing** * Evaluate medical information...looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license… more
    Lincoln Financial (06/10/25)
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  • RN Mobile MDS Coordinator

    CommuniCare Health Services Corporate (Martinsburg, WV)
    RN Mobile MDS Coordinator, Registered Nurse CommuniCare Health Services is currently looking to fill the key position of Mobile MDS Coordinator, RN for ... successful candidate for the position must have a valid RN license in West Virginia, as well as previous...visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization ,… more
    CommuniCare Health Services Corporate (06/03/25)
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  • Assistant Vice President

    Sedgwick (Charleston, WV)
    …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple ... business lines; and to provide expertise in client specific case management and utilization review requirements and ensure customer satisfaction through the… more
    Sedgwick (05/23/25)
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  • Nurse Manager / RN Required

    BrightSpring Health Services (Dunbar, WV)
    …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse ( RN ) in good standing and currently licensed by ... and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate hours on… more
    BrightSpring Health Services (04/24/25)
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