- Humana (Montgomery, AL)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CenterWell (Montgomery, AL)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Montgomery, AL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Montgomery, AL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Evolent (Montgomery, AL)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Aveanna Healthcare (Pelham, AL)
- Hospice Registered Nurse RN Part Time Weekends ApplyRefer a FriendBack Job Details Requisition #: 208777 Location: Pelham, AL 35124 Category: Nursing Salary: $31.00 ... hour Position Details Position Overview: TheHospiceRegistered Nurseis responsible for pain management , symptom control in the delivery of care to hospice patients,… more
- CVS Health (Montevallo, AL)
- …high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical ... physical, behavioral, and psychosocial services. **Key Responsibilities** + Conduct in- home , face-to-face assessments using comprehensive tools for members enrolled… more
- Fresenius Medical Center (Huntsville, AL)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Fresenius Medical Center (Birmingham, AL)
- …Quality, and Technical Services departments. + Collaborates with or functions as the Home Therapies Program Manager to oversee the facility's Home Therapies ... Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more
- CenterWell (Butler, AL)
- …and reliable transportation. + Two years as a Registered Nurse in a home care, with at least one-year of management experience preferred. **Scheduled Weekly ... patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission… more
- CenterWell (Prattville, AL)
- …+ Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. **Scheduled Weekly ... patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission… more
- CVS Health (Montgomery, AL)
- …all with heart, each and every day. **Position Summary** **This is a work at home position with working hours of one of the following shifts 8:00/8:30/9:00 AM - ... health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care,… more
- BrightSpring Health Services (Springville, AL)
- … utilization and hospital admission reduction + Provides survey management support/ follow-up/and coordination of corrective actions plans related to care ... and direction in performance improvement, provision of clinical services, survey management , documentation management , incident management , EMR/EHR… more
- Sharecare (Montgomery, AL)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Humana (Montgomery, AL)
- …others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more
- Gentiva (Montgomery, AL)
- …licensed Registered Nurse (RN) with strong leadership experience in hospice care, home health, or clinical operations management . If you're a natural leader ... budgeting while driving branch revenue growth through census development, referral management , and efficient resource utilization + Maintain strong relationships… more
- Community Health Systems (Huntsville, AL)
- …health, or nursing home setting required + 2-4 years of care management experience preferred **Knowledge, Skills and Abilities** + Strong understanding of case ... coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves… more