- Elevance Health (Atlanta, GA)
- ** Telephonic Nurse Case Manager I - $3000 Sign-On Bonus Offered** **Location: This is a virtual position, but you must reside in the State of Georgia.** **Work ... must complete the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager I** is responsible for telephonic care… more
- UPMC (Pittsburgh, PA)
- Are you an experienced nurse with a background in case management? Are you interested in the opportunity to work from home? UPMC Health Plan is looking for you! We ... are hiring a full-time Telephonic Care Manager to join the Home and Community-Based...Insurance Services Division. **Responsibilities:** + Present complex members for review by the interdisciplinary team summarizing clinical and social… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review… more
- CVS Health (Raleigh, NC)
- …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is...Strong telephonic communication skills - Experience with computers toggling between… more
- CVS Health (Raleigh, NC)
- …a keyboard and speaking to customers. Preferred Qualifications: - 1+ years' experience Utilization Review experience -1+ years' experience Managed Care - Strong ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is...telephonic communication skills -Ability to exercise independent and sound… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to ... 2 Holiday a year. The Utilization Management Nurse 2 Front End Review uses clinical...treatment and discharge planning, which will include about 50% telephonic outreach + Understands department, segment, and organizational strategy… more
- State of Michigan (Lansing, MI)
- …1-2 years + Less than 1 year + None 07 This position is a telephonic prior authorization review process, do you have any professional nursing experience working ... Medicaid Utilization Analyst 9-P11 - BPHASA Medical Equipment and...and Inclusion Plan. This position functions as a clinical review professional responsible for conducting clinical reviews of applications/requests… more
- Universal Health Services (Conway, SC)
- …Job Posting Lighthouse Behavioral Health Hospital is hiring for a Part Time RN Utilization Review Coordinator. Utilization Review / Risk Management ... UHS and its 300+ Subsidiaries! Flexible Schedule Qualifications Job Requirements The Utilization Review Coordinator position will consist of Four 8-hour Daylight… more
- Commonwealth Care Alliance (Springfield, MA)
- …accepted medical guidelines, and appropriate scope of practice. + Provide regularly scheduled telephonic calls to support the management of chronic disease or end of ... with understanding their CCA Health Benefit package. + Perform annual comprehensive telephonic assessments and coordinate any needed follow up from results. +… more
- Health Advocates Network (Harrisburg, PA)
- …setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An ... R&E Nurse - Med Care Services- Advanced **Pay Rate** :...(MA), health care services, human services, long term care, utilization review , or knowledge of home care… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: ... Nurse Case Manager Location: Poughkeepsie, NY, United States...physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the… more
- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
- The Cigna Group (Mobile, AL)
- …skills + Typing and computer knowledge- able to type 35WPM + Knowledge of utilization review requirements and procedures + Knowledge of current health care ... and metrics for customers and communicates to provider + Review STAR summary gap report (daily) by payor +...include primary care physician and specialist appointment scheduling + Nurse notifies PCP daily of admissions and discharges +… more
- NJM Insurance (Trenton, NJ)
- …Workers' Compensation line of business by performing prospective and retrospective Utilization Review of pharmaceutical/medication requests in accordance with ... and causally related. + Evaluate requests that are routed for clinical review based upon established criteria to issue appropriate and timely determinations on… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- Nurse Practitioner - ISNP (Full-Time) Brooklyn, NY, USA Req #363 Monday, June 3, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare ... plans they need for healthy living. JOB SUMMARY: The nurse practitioner treats acute and chronic conditions in place...Identify, treat, and document changes in condition + Order, review and/or follow-up with treatments and diagnostic testing +… more
- Centers Plan for Healthy Living (Bronx, NY)
- Nurse Practitioner - ISNP (Full-Time & Part-Time) Bronx, NY, USA Req #8 Monday, June 3, 2024 Our NP CHAMPIONS advocate to i mprove the health and quality of life of ... plans they need for healthy living. JOB SUMMARY: The nurse practitioner treats acute and chronic conditions in place...Identify, treat, and document changes in condition + Order, review and/or follow-up with treatments and diagnostic testing +… more
- The Cigna Group (Harlingen, TX)
- …skills * Typing and computer knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health care ... participate in weekly Complete Health Team rounds * Perform telephonic outreach or home visits, as needed * Communicates...* None **Experience:** * Current Licensure as a Registered Nurse , in the state of Texas in good standing.… more
- The Cigna Group (Philadelphia, PA)
- …skills + Typing and computer knowledge- able to type 35WPM + Knowledge of utilization review requirements and procedures + Knowledge of current health care ... participate in weekly Complete Health Team rounds + Perform telephonic outreach or home visits, as needed + Communicates...None **Qualifications** : + Current Licensure as a registered nurse , in the state of residency. in good standing.… more
- The Cigna Group (Mesa, AZ)
- **Summary** The Nurse Case Management Lead Analyst is an integral member of the Care Management department as part of Evernorth Care Group (ENCG) primary care team. ... on the management of high- and rising-risk, disease burdened members. The Nurse Case Management Lead Analyst utilizes clinical skills to assess, plan, implement,… more