- Centene Corporation (Madison, WI)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... (except Thanksgiving, Christmas, and New Years)** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …and record relevant] patient information. Completed work should need only a general review by a registered nurse for appropriateness and conformity with ... Summary The Licensed Practical Nurse (LPN) is located at our East Clinic...verification. Please read the announcement in its entirety and review your responses for accuracy before you submit this… more
- Molina Healthcare (Madison, WI)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Meriter-UnityPoint Health (Madison, WI)
- 14110BRDepartment Name:HSP Nurse Res/ Nurse Extern Location:Meriter Hospital Job Description: Nurse Extern Program for Student Nurses May 25th, 2025 - August ... nurturing environment under the guidance of an experienced registered nurse . Our Student Nurse Extern Program will...nursing + Has completed at least one acute care clinical + Is certified in Health Care Provider BLS… more
- Humana (Madison, WI)
- …supports the goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for appropriate ... of professional onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN, Intern will...clinical judgment and refers to internal stakeholders for review depending on case findings. + Educates providers on… more
- Centers for Independence (Madison, WI)
- ** Nurse Manager Pediatrics** **Job Details** **Job Location** MCFI Main Campus - Milwaukee, WI **Position Type** Full Time **Education Level** 4 Year Degree **Travel ... **Job Shift** Day **Job Category** Finance **Description** **Job Purpose:** The clinical manager is responsible for organizing and directing the daily operations… more
- Evolent (Madison, WI)
- …Participates in the development and implementation of new strategies to make the clinical review process more efficient through people, processes, and technology ... will be the single point of responsibility for all clinical operations inclusive of nurse , physician, and...highly desirable. + High level of financial acumen, with prior P&L responsibility preferred. + Proficiency creating and leading… more
- Humana (Madison, WI)
- …Nursing Facility experience** + Previous experience in utilization management required + Prior clinical experience preferably in an acute care, skilled or ... help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to...The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Molina Healthcare (Madison, WI)
- **JOB DESCRIPTION** **_For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …Assigned Duties: Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... Shares educational findings, experiences, and ideas with peers. Questions clinical practices for the purpose of providing evidence-based care....Nursing may have opportunity to become registered as a nurse with a state licensing board prior … more
- SSM Health (Madison, WI)
- …**Worker Type:** Regular **Job Highlights:** **SSM is looking for an experienced nurse with Hospice/Liaison or Case Management experience that has a dynamic ... departments, such as branch departments, business development etc. * Eligibility/Chart Review to determine appropriateness for continuum of care services Schedule is… more
- Fresenius Medical Center (Baraboo, WI)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... + Monitor patients' response to dialysis therapy. + Obtain vital signs prior to reinfusion; perform all relevant functions necessary for the discontinuation of… more
- WelbeHealth (Madison, WI)
- …of our program is guided by our interdisciplinary team (IDT), composed of clinical and non- clinical members who work cohesively to provide all-inclusive care ... Director, Compliance Operations is accountable for developing, coordinating and monitoring clinical and PACE elements of the compliance program. Under the direction… more