- The Cigna Group (Houston, TX)
- …and/or additional state licensure as needed 3) 3+ years of experience as a Registered Nurse with experience in internal medicine or adult medicine 4) Proficient ... The RN serves as the key contact point for...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing… more
- ERP International (Scott AFB, IL)
- **Overview** ERP International is seeking a full time ** Registered Nurse ( RN )** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL ... a one-hour lunch between 11:00am and 1:00pm No Weekends, No Holidays, No Call! **Core Registered Nurse Duties:** The duties include, but are not limited to the… more
- AmeriHealth Caritas (Florence, SC)
- …of Science in Nursing **(BSN)** is required and must hold a current and unrestricted ** Registered Nurse ( RN )** license in good standing in South Carolina or ... **REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care...Management ID**: 34390 **Job Brief** This position is a telephonic Care Manager that is required to reside in… more
- AmeriHealth Caritas (Greenville, SC)
- …Bachelor of Science in Nursing (BSN) is required and must hold a current and unrestricted Registered Nurse ( RN ) license in good standing in South Carolina or ... **Care Manager II Registered Nurse (BSN) - Foster Care...Management ID**: 34482 **Job Brief** This position is a telephonic Care Manager, open to candidates in the SC… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... would like in this role: Employee will be providing telephonic case management for our members. + Past job...case management for our members. + Past job instability. Registered nurses MUST have 4 years or more of… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Utilization Management Nurse Specialist RN...Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review ,… more
- VNS Health (Manhattan, NY)
- …as assigned. QualificationsLicenses and Certifications: Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York ... subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- CVS Health (Phoenix, AZ)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the… more
- CVS Health (Austin, TX)
- …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications: + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is...Required Qualifications: + Must have active current and unrestricted RN licensure in state of residence + 2+ years… more
- Commonwealth Care Alliance (Boston, MA)
- …standing in Massachusetts **Required Experience (must have):** + 7+ Years Experience as a Registered Nurse in a high-touch clinical environment or home care + 3+ ... RNs and LPNs and their performance by ensuring specific RN and LPN key performance metrics and daily clinical...interprofessional team. This can include 1:1 meetings with staff, review of productivity standards, and ensure quality of care… more
- Actalent (Riverside, CA)
- …+ Clarify orders related to admission status and patient management. Essential Skills + Registered Nurse ( RN ) license. + Experience in an acute hospital ... Job Title: RN Case Manager Job Description The RN...of nursing, administrators, and physicians. Additionally, the position involves telephonic case management for the Special Needs Department (SNP)… more
- Trinity Health (Albany, NY)
- …other related duties as assigned Experience and Requirements + Active Licensure as a registered nurse , preferably with a **bachelor's degree** in nursing from an ... Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals...accredited school and Certified Registered Rehab Nurse preferred (CRRN). + A… more
- CVS Health (Little Rock, AR)
- …- Perform medical necessity reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting - A Registered Nurse that holds an active, unrestricted...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- Baystate Health (Springfield, MA)
- …- American Heart AssociationAmerican Heart Association, Driver License - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... The **ACO Nurse Care Manager i** s responsible for the...face visits, home visits if necessary, as well as telephonic interactions. In addition, they will assist with advance… more
- The Cigna Group (Bloomfield, CT)
- …skills. + Typing and computer knowledge- able to type 35WPM. + Knowledge of utilization review requirements and procedures. + Knowledge of current health care ... weekly Complete Health Team rounds -market dependent. + Perform telephonic outreach. + Communicates with all departments to resolve...providers office. **Experience** : + Current Licensure as a registered nurse , in the state of residence… more
- Northern Light Health (Pittsfield, ME)
- …various data to trace potential causes and relevant details. Credentials + Required Registered Nurse Education + Required Associate's Degree Working Conditions + ... to 4:30 pm Summary: The position's purpose is to assist and perform direct/ telephonic patient care as required for triage of calls, provider directives, protocols,… more
- University of Virginia (Haymarket, VA)
- …the payor side will also be considered. Licensure: Licensed to practice as a Registered Nurse in the Commonwealth of Virginia PHYSICAL DEMANDS Job requires ... current. Admission procedures or appeals are communicated to insurance carriers via telephonic /fax/on-line review in an organized and timely fashion. Timely… more
- Kepro (Oakland City, IN)
- …community. + Ensure day-to-day processes are conducted in accordance with the Utilization Review Accreditation Commission (URAC) and other regulatory standards. ... in the public sector. Acentra is looking for an RN Complex Case Manager - Hybrid (Southwest Indiana Counties:...coordination in defined areas of coal mine states and telephonic care coordination across the United States. An integrated… more
- CVS Health (Miami, FL)
- …experience + Certified Care Manager (CCM) Certification + Managed care or utilization review experience **Education** + Associates degree or Diploma in ... personal, convenient and affordable. **Position Summary** The Pediatric Care Manager RN will support a population of primarily medically complex pediatric members… more
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