- Humana (Richmond, VA)
- …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 (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CVS Health (Richmond, VA)
- …state of residence. 1+ years of clinical experience **Preferred Qualifications** Utilization Management experience Managed Care Experience Proficiency in grammar ... services. Maintains accurate and complete documentation to meet risk management , regulatory, and accreditation requirements. Promotes communication, both internally… more
- CenterWell (Richmond, VA)
- …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 (Richmond, VA)
- **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
- Elevance Health (Richmond, VA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... and may require reporting to the nearest office.** The ** Utilization Management Representative I** is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- CVS Health (Richmond, VA)
- …Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources ... team will review prior claims to address potential impact on current case management and eligibility status. Assessments and/or questionnaires are designed to use a… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- Summary Registered Nurse - Float Pool Demonstrates integration of biopsychosocial concepts, cognitive skills, and technically competent practice while providing care ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- CVS Health (Richmond, VA)
- …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
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …the EDRP application. Former EDRP participants ineligible to apply. Responsibilities Registered Nurse - Inpatient Spinal Cord The Inpatient Staff Registered Nurse ... nursing practice and determines the appropriate delegation of tasks consistent with the nurse 's obligation to provide optimal care. The focus is on individual growth… more
- ChenMed (Richmond, VA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- HCA Healthcare (Richmond, VA)
- …of RN experience in a hospital setting preferred. + Previous case management or utilization review experience preferred. Johnston-Willis Hospital has provided ... opportunity to make a real impact. As a **Registered Nurse RN Case Manager** you can be a part...location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential… more
- ChenMed (Richmond, VA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Evolent (Richmond, VA)
- …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
- Elevance Health (Richmond, VA)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …(ACE) Program** **is a 12-week program designed specifically to support the new-to-practice Nurse in preparation for a RN bedside role. ACE will help you find ... being alone. The continuing education and the ability to work with an experienced nurse provides you with confidence to ask questions, an ability to admit the things… more
- Bon Secours Mercy Health (Richmond, VA)
- …clinicians are recognized for clinical and operational excellence. Job Description **Registered Nurse (RN) - FT - Orthopedic Operating Room - St. Mary's Hospital** ... partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based… more
- Fresenius Medical Center (Richmond, VA)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Fresenius Medical Center (Louisa, VA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Elevance Health (Richmond, VA)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... ensures essential face-to-face onboarding and skill development._ The **Medical Management Clinician Sr** is responsible for ensuring appropriate, consistent… more