- Baylor Scott & White Health (Richmond, VA)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff.... management , and budget control. Departments involved are Utilization Management , Case Management , and… more
- Humana (Richmond, VA)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Elevance Health (Richmond, VA)
- Job Description **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- HCA Healthcare (Richmond, VA)
- …concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan + As a member of Case Management team ... Graduate of an accredited school of nursing. + Commercial Utilization Management and/or Case Management ...encourage you to apply for our Case Manager Registered Nurse RN PRN opening. We review all… more
- Humana (Richmond, VA)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Elevance Health (Richmond, VA)
- **Medical Management Nurse ** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, ... pm (EST) shift rotation twice a month.** The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- HCA Healthcare (Richmond, VA)
- …**3+ years of RN experience in a hospital setting preferred.** + **Previous case management or utilization review experience preferred.** CJW Medical Center ... opportunity to make a real impact. As a Registered Nurse RN Case Manager you can be a part...may vary by location._ We are seeking a Registered Nurse RN Case Manager for our team to ensure… more
- Bon Secours Mercy Health (Richmond, VA)
- …an environment where associates want to work and help communities thrive. **Registered Nurse (RN) - Physician Office - Bon Secours - Cardiology, Reynolds - Richmond, ... step down or critical care experience as a Registered Nurse + Experience within a physician practice setting. +...format and content of patient records. + Ability to review records, read physician documentation and verify patient identification.… 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 is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Molina Healthcare (Richmond, VA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... For this position we are seeking a (RN) Registered Nurse or LCSW who lives in VIRGINIA and must...years in one or more of the following areas: utilization management , case management , care… more
- Evolent (Richmond, VA)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Evolent (Richmond, VA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- HCA Healthcare (Richmond, VA)
- …initiatives. + Assess cost-reduction opportunities including: + Appropriate administration and management of ED department + Assess skill mix opportunities, agency ... nurse usage, and staffing for ED + Identifies facility...that impact ED throughput + Supply, medication, and resource utilization + Appropriate assignment of patients being admitted to… more