- The Cigna Group (Bloomfield, CT)
- …addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of ... include, but not limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to differentiate… more
- Hartford HealthCare (Torrington, CT)
- …Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP ... Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other… more
- Humana (Hartford, CT)
- …reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable Medical ... Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the… more
- The Cigna Group (Bloomfield, CT)
- …preferred + 5+ years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency with Microsoft Office ... Nurse Case Management Lead Analyst- Nurse Clinician...years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- …FOR A CONNECTICUT LICENSE, PLEASE: + Review the eligibility and documentation requirements ... Head Nurse (32 Hour) Office/On-site Recruitment # 240919-4356HJ-001 Location...workflow and determine priorities. + Schedule, assign, oversee, and review work. + Make recommendations for personnel actions such… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- …FOR A CONNECTICUT LICENSE, PLEASE: + Review the eligibility and documentation requirements ... Head Nurse (40 Hour) Office/On-site Recruitment # 240919-4356FL-001 Location...biographic information, select your license type and select 'SEARCH'. Review the results and select the 'Next' button. Check… more
- Prime Therapeutics (Hartford, CT)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Elevance Health (Wallingford, CT)
- **Telephonic Nurse Case Manager Senior** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of… more
- Elevance Health (Wallingford, CT)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more
- Highmark Health (Hartford, CT)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Hartford HealthCare (West Hartford, CT)
- …- *Stroke GOLD PLUS Achievement Award winner* in 2016. *Physician Assistant or Nurse Practitioner (APRN) Role Scope* Along with practicing as a full time, clinical ... meets with their teams routinely (monthly) to provide updates, review areas for improvement, and listen and respond to...coordinating scheduling. Assists in determining suitability for team member utilization of PTO and CME excused time. . Assists… more
- Masonicare (Wallingford, CT)
- …and interdisciplinary care team. + Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings. + Assists with ... in services and departmental staff and inservice meetings. Education: Requires a Registered Nurse with a current Connecticut State license and a BSN or MSN graduate… more
- Masonicare (Wallingford, CT)
- …staff, prepares on-call schedules, plans and organizes daily assignments including the review and assignment of new patient referrals. + Supervises all assigned ... reviews to assess the appropriateness of care plan, the utilization of services and to ensure complete documentation of...by the American Nurses' Association as a community health nurse or completion of at least six credits received… more
- Hartford HealthCare (Hartford, CT)
- …and multidisciplinary care team, including quality of care measures and review . . Collaboration with other departments caring for stroke patients (incl. ... monitors progress during the year. . Oversees AP scheduling and resource utilization in collaboration with residency (if applicable). Oversees payroll activities The… more
- Hartford HealthCare (Middletown, CT)
- …with all admission related staff ensuring expediency of client admission including Utilization Review , Nursing, Admission Specialists and staff in related ... urine drug screens, take client vitals, and report abnormal values/trends to staff nurse . Complete safety checks throughout the clients stay. 4. Orient clients to… more
- CVS Health (Hartford, CT)
- …Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment. A minimum of two years' ... policy. Preferred Qualifications : Oklahoma residency preferred Oklahoma-licensed registered nurse preferred OR be certified as a Certified Professional in… more
- CVS Health (Hartford, CT)
- …supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. ... Management Associate position duties include (not all encompassing): -Responsible for initial review and triage of Care Team tasks. -Identifies principal reason for… more