- CenterWell (Juneau, AK)
- …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
- Evolent (Juneau, AK)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Evolent (Juneau, AK)
- …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
- Intermountain Health (Juneau, AK)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- HCA Healthcare (Anchorage, AK)
- …about delivering patient-centered care?** Submit your application for Operating Room Registered Nurse position and spend more time at the bedside with the patient. ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Alaska Surgery Center! **Job… more
- HCA Healthcare (Anchorage, AK)
- …about delivering patient-centered care?** Submit your application for Operating Room Registered Nurse position and spend more time at the bedside with the patient. ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Surgery Center of Anchorage!… more
- PeaceHealth (Ketchikan, AK)
- …acute care hospital and + Preferred: Utilization management /quality management experience **Credentials** + Required: Registered Nurse in state of ... is seeking a RN Care Coordinator Inpatient - Care Management for a Part Time, 0.80 FTE, Day position....inpatient populations across the continuum of illness, promote effective utilization and monitoring of health care resources, and assumes… more
- Highmark Health (Juneau, AK)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- Providence (AK)
- …in a medical record. + 2 years - HEDIS, Quality management /quality improvement/ utilization review auditing experience, including experience in auditing ... Qualification:** + Technical certification/licensure in the area of Medical Assistant, Certified Nurse Assistant, or Licensed Practical Nurse upon hire. + HS… more
- Datavant (Juneau, AK)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- Sharecare (Juneau, AK)
- …/ 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
- Highmark Health (Juneau, AK)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- HCA Healthcare (Anchorage, AK)
- …Life Support Course (BLS or BCLS) and Certification. + Certification in case management or utilization review preferred. + InterQual experience preferred. HCA ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...is responsible for the following functions: Care Coordination, Resource Management , and Discharge Planning. The RN Case Manager will… more
- GE Aerospace (Anchorage, AK)
- …does not directly own infrastructure platforms. The role accelerates digital utilization by standardizing data models, establishing reusable patterns, ensuring high ... data models, semantic layers, and reusable transformation patterns. **Data Management and Governance** + Implement data governance with domain-aligned stewardship,… more
- Community Health Systems (Palmer, AK)
- …huddles. + Monitors patient flow, manages bed assignments, and optimizes resource utilization within the unit. + Conducts employee and patient rounding to evaluate ... are available and properly utilized while maintaining cost-effective resource management . + Facilitates ongoing education and professional development for nursing… more
- Oracle (Juneau, AK)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- Community Health Systems (Palmer, AK)
- …huddles. + Monitors patient flow, manages bed assignments, and optimizes resource utilization within the unit. + Conducts employee and patient rounding to evaluate ... are available and properly utilized while maintaining cost-effective resource management . + Facilitates ongoing education and professional development for nursing… more