- 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Jackson, MS)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Evolent (Jackson, MS)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Community Health Systems (Brandon, MS)
- …concerns with professionalism and empathy. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required ... with hospital policies and regulatory standards, serving as a resource for clinical and non- clinical staff. **Essential Functions** + Oversees hospital… more
- TEKsystems (Jackson, MS)
- …questions addressed. + Verify each review is supported by current clinical citations and references from reputable medical journals/publications. + Ensure content, ... quality, availability, and compliance with policies/procedures. + Promote efficient utilization of company resources. + Participate in educational and training… more
- Fresenius Medical Center (Jackson, MS)
- …of staff as assigned. + Performs and sets-up in-services regarding equipment, supplies and clinical for all staff. + Coordinates all aspects of patient care with the ... Policies. + Participates in cost control initiatives. Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Humana (Jackson, MS)
- …We are not able to hire candidates that are currently living in Puerto Rico. + Registered Nurse with current in-state RN license + At least 3 years of varied ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care... clinical RN nursing experience + Current TRICARE experience +… more
- CVS Health (Jackson, MS)
- …in state of residence - 3+ years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS ... Works closely with functional area management to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial,… more
- Highmark Health (Jackson, MS)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... 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 (Flowood, MS)
- …software systems, and data analysis tools. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required + ... with hospital policies and regulatory standards, serving as a resource for clinical and non- clinical staff. **Essential Functions** + Oversees hospital… more