- Centene Corporation (Jefferson City, MO)
- …28 million members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various ... more
- Elevance Health (Denver, CO)
- ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... more
- Elevance Health (GA)
- ** Telephonic Nurse Case Manager I** **Location: This is a virtual position, but you must reside in the State of Georgia.** **Work schedule: Monday - Friday 11:00am - ... more
- LA Care Health Plan (Los Angeles, CA)
- …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... more
- CVS Health (Olympia, WA)
- …Qualifications** -1+ years' experience in either Precertification or Utilization Review -1+ years' experience Managed Care -Strong telephonic communication ... more
- CVS Health (Albany, NY)
- …(recent defined as in the past 10 years). **Preferred Qualifications:** -2 years of Utilization Review experience -2 years of Managed Care background -Strong ... more
- Sanford Health (Sioux Falls, SD)
- …of members. For individuals supporting clinical areas, additional duties are: Utilization management performs resource benefit policy management, triages inbound and ... more
- Actalent (Dallas, TX)
- …of concurrent review experience and/or discharge planning + 2 years of utilization review /management experience + 1 year of experience within Case Management ... more
- ChenMed (Newport News, VA)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... more
- CommonSpirit Health (Houston, TX)
- …intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... more
- ChenMed (Norfolk, VA)
- …healthcare setting experience is preferred. + Minimum of two (2) years of utilization review , case management, home health and/or discharge planning experience ... more
- ChenMed (Virginia Beach, VA)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... more
- Baystate Health (Springfield, MA)
- …through face-to-face visits, home visits, if necessary, as well as telephonic interactions. In addition, they will assist with advance directives, palliative ... more
- Centene Corporation (Tallahassee, FL)
- …area (ie MTM services, Quality Improvement Projects, DUR, etc.). + Engages in drug utilization review (DUR) by supporting the execution of DUR initiatives via ... more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... more
- Highmark Health (Madison, WI)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... more
- Sharecare (Little Rock, AR)
- …for supporting goals and objectives of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, ... more
- Albany Medical Center (Albany, NY)
- …the RN may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's specific care plan ... more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... more
- CVS Health (Topeka, KS)
- …Spanish. **Preferred Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and ... more
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