- Molina Healthcare (Vancouver, WA)
- …knowledge on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse ( RN ) Program and an Associate's or Bachelor's ... settings. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted State Registered Nursing ( RN ) or State Clinical Social Worker/Counseling… more
- Humana (Salem, OR)
- …an impact** **Required Qualifications** **Must meet one of the following:** + Active unrestricted registered nurse license in the state of Virginia or obtain a ... problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change,… more
- Molina Healthcare (Vancouver, WA)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Molina Healthcare (Vancouver, WA)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of… more
- PeaceHealth (Vancouver, WA)
- …(or may have equivalent combination of education and/or experience) + Required: WA State Registered Nurse License or current MSL + Required Upon Hire: Healthcare ... teach. (Required) + Knowledge of discharge planning, health care reimbursement, utilization review processes and Medicare admission status/classification level.… more
- Molina Healthcare (Vancouver, WA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Humana (Salem, OR)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- Molina Healthcare (Vancouver, WA)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . * Incorporate leadership and communication skills to work ... care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted State Registered Nursing ( RN ) license in good standing. **PREFERRED… more
- Insight Global (Oregon City, OR)
- …-Triages minor to emergent situations. -Respond to medical emergencies. -Performs nurse visits and administers medications and immunizations as ordered by an ... primary care procedures as necessary in times of staffing constraints. -Performs RN led patient visits for health maintenance, patient education, and treatment of… more
- Providence (Portland, OR)
- …hire. + Bachelor's degree in Nursing or higher within 3 years of hire. + Oregon Registered Nurse License upon hire + 2 years Acute care hospital or community ... systems. + 1 year Home health, mental health, substance use, hospice, utilization review , discharge planning or care management experience **Preferred… more
- Evolent (Salem, OR)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + Cardiology and Oncology Healthcare… more
- Highmark Health (Salem, OR)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Molina Healthcare (Vancouver, WA)
- …identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity,... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of … more
- Molina Healthcare (Vancouver, WA)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state… more
- Humana (Salem, OR)
- …**Required Qualifications:** **Must meet** **one** **of the following:** + Active unrestricted registered nurse license in the state of Virginia or reside ... case manager required. **Additional Information:** **Workstyle:** Remote work at Home **Location for Registered Nurse :** must reside in the state of Virginia or… more
- Molina Healthcare (Vancouver, WA)
- …acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must ... MCO (Managed Care) **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). Active, unrestricted Compact RN… more
- Guardian Life (Salem, OR)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- Sedgwick (Salem, OR)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- Molina Healthcare (Vancouver, WA)
- …on business need (up to 25%) **Job Qualifications** * Active and unrestricted Registered Nurse ( RN ) license or independent behavioral health license ... **Job Description** Looking for a Registrared Nurse or Licensed Social worker to support HealthPlans within Molina Healthcare. In this position you will be assisting… more
- Veterans Affairs, Veterans Health Administration (Vancouver, WA)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... the VHA Education Loan Repayment Services program office after review of EDRP application. Former EDRP participants ineligible to...outcomes at the program or service level. The CLC RN collaborates with the Minimum Data Set (MDS) coordinator… more