- Humana (Little Rock, AR)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Little Rock, AR)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Little Rock, AR)
- …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 (Little Rock, AR)
- **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 (Little Rock, AR)
- …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 (Little Rock, AR)
- …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
- Catholic Health Initiatives (Little Rock, AR)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria. +… more
- Community Health Systems (Siloam Springs, AR)
- **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under the ... supervision of a Registered Nurse or physician. This role involves reviewing medical records...escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee. + Identifies avoidable… more
- Community Health Systems (Bentonville, AR)
- …place to live! **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities ... under the supervision of a Registered Nurse or physician. This role involves reviewing medical records...escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee. + Identifies avoidable… more
- Community Health Systems (Siloam Springs, AR)
- …for nursing operations across assigned area(s), ensuring efficient resource utilization , regulatory compliance, and quality outcomes. + Oversees the development, ... and manages operating and capital budgets for assigned departments; ensures efficient utilization of financial and staffing resources. + Promotes a culture of… more
- Intermountain Health (Little Rock, AR)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- Sharecare (Little Rock, AR)
- …/ 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
- STG International (Mountain Home, AR)
- …to ensure compliance and patient safety. *Participates in quality improvement, care management , risk management , peer review, utilization review, clinical ... in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership to CBOC clinicians. *Evaluate the effectiveness of… more
- Community Health Systems (Bentonville, AR)
- Offering up to a $20,000 Sign-On for eligible Full Time, Registered Nurse candidates! **Why Northwest Health?** We know it's not just about finding a job. It's about ... coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves… more
- Highmark Health (Little Rock, AR)
- …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
- Community Health Systems (Bentonville, AR)
- Offering up to a $20,000 Sign-On for eligible Full Time, Registered Nurse candidates! **Why Northwest Health?** We know it's not just about finding a job. It's about ... huddles. + Monitors patient flow, manages bed assignments, and optimizes resource utilization within the unit. + Conducts employee and patient rounding to evaluate… more
- Community Health Systems (Springdale, AR)
- …coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves ... to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams (IDT) to… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …+ Education + Current Arkansas State RN or LPN license. + Experience + Nurse with previous case management experience preferred, but not necessary. Effective ... care and cost effectiveness through the integration and functions of case management and utilization review. The person in this position is self-directed, has a… more
- United Therapeutics (AR)
- …awareness during the entire access process which may include formulary coverage/ utilization management criteria, insurance forms & procedures, benefits ... + Experience educating HCPs on client specific patient service programs (ie copay, nurse education, patient assistance, etc.) + Ability to manage ambiguity & problem… more
- Oracle (Little Rock, AR)
- …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