- CareSource (Jackson, MS)
- …adaptation, and self-care through effective care coordination and case management Facilitate coordination, communication and collaboration with the member the ... and monitoring of concerns or issues Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management… more
- CareSource (Jackson, MS)
- …adaptation, and self-care through effective care coordination and case management Facilitate coordination, communication and collaboration with the member the ... and monitoring of concerns or issues Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management… more
- CenterWell (Jackson, MS)
- …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 (Jackson, MS)
- **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
- Actalent (Jackson, MS)
- …Trucare Cloud preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel, and ... Clinical Review Nurse - Concurrent Review Location: Remote - Candidates...systems + Medicaid, Medicare or insurance-related knowledge + Prior utilization management experience What We Offer +… more
- Evolent (Jackson, MS)
- …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
- Humana (Jackson, MS)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Sharecare (Jackson, MS)
- …/ 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
- Datavant (Jackson, MS)
- …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
- Highmark Health (Jackson, MS)
- …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
- GE Aerospace (Jackson, MS)
- …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 (Jackson, MS)
- …The Director focuses on enhancing patient safety, optimizing resource utilization , and promoting professional development for staff, all while aligning ... policies and standards. **Leadership Responsibilities** + **Supervision and Staff Management ** + Provides leadership, mentorship and professional development opportunities… more
- Oracle (Jackson, MS)
- …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 (Flowood, MS)
- …hospital census, coordinates admissions, discharges, and transfers, and ensures optimal bed utilization . + Acts as the administrative point of contact for staff, ... all policies and standards. **Leadership Responsibilities** + **Supervision and Staff Management ** + Supervises, trains and oversees departmental staff. + Schedules… more
