- Elevance Health (Atlanta, GA)
- ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... complete the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager II** is responsible for care management within… more
- ICW Group (Woodland Hills, CA)
- …assessment and evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical ... regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… more
- UPMC (Pittsburgh, PA)
- …County Care Management Team. The team is looking to hire either an RN (as a Telephonic Care Manager) or a social worker (as a Health Care Manager). The team is based ... implemented. + Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues. + Preserve confidentiality of the member. +… 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 ... and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would like in this… 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: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- CVS Health (Harrisburg, PA)
- …needs + Holiday rotation required **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... convenient and affordable. Requisition Job Description **Position Summary:** **This Utilization Management (UM) Nurse Consultant role is...Strong telephonic communication skills + Time efficient and highly organized… more
- CVS Health (Albany, NY)
- …9pm EST depending on business needs **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...Strong telephonic communication skills - Time efficient and highly organized… more
- CVS Health (Tallahassee, FL)
- …+ Must live in Eastern time zone **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + Strong ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is...telephonic communication skills + 1+ years' experience with Microsoft… more
- The Cigna Group (Baltimore, MD)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
- The Cigna Group (Houston, TX)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… 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:** $28...(MA), health care services, human services, long term care, utilization review , or knowledge of home care… more
- ERP International (Scott AFB, IL)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse (RN)** to support the Family Medicine Clinic -375th Medical Group at Scott AFB, IL… more
- Veterans Affairs, Veterans Health Administration (Greenville, NC)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance… more
- Spectrum Health Services (Philadelphia, PA)
- …from the hospital, specialty care practices, health plan staff, and others, the Nurse Care Manager identifies and proactively manages the needs of patients with high ... health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management basis appropriate… 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: ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more
- Lowe's (Charlotte, NC)
- …in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a clinical ... **Your Impact** The Care Manager is a telephonic medical case management position with emphasis on...for medically managing a minimum caseload of 65 including review of claims identified for Medicare Set-Aside. **What you… more
- The Cigna Group (Nashville, TN)
- …with chronic illnesses in an effort improve clinical outcomes and decrease utilization . We provide physical, emotional, and spiritual support for patients who are ... facing life-threatening illnesses. We are currently seeking nurse practitioners who are passionate about serious illness care and management to join our growing… more
- Sharecare (Columbus, OH)
- …of the care enhancement program by ** ** providing high quality telephonic support in an appropriate, efficient and cost-effective manner while ensuring high ... appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for early… 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 ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
- Fallon Health (Worcester, MA)
- …represent Fallon Health in a positive way. SWCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ... rounds and huddles o Works with members of the Utilization Management Department assisting with difficult or complex care...to engage in Interdisciplinary team meetings o Works with Nurse Case Managers and Navigators to coordinate a continuum… more
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