- CVS Health (Topeka, KS)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Topeka, KS)
- …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 (Topeka, KS)
- **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 (Overland Park, KS)
- ** Utilization Management Representative II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... AM and 5:00 PM Pacific. The **Behavioral Health (BH) Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- HCA Healthcare (Overland Park, KS)
- **Description** **Introduction** Do you have the career opportunities as a(an) PRN Registered Nurse Case Manager you want with your current employer? We have an ... caring group of colleagues. Do you want to work as a(an) PRN Registered Nurse Case Manager where your passion for creating positive patient interactions is valued?… more
- Evolent (Topeka, KS)
- …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
- Intermountain Health (Topeka, KS)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- Sharecare (Topeka, KS)
- …/ 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
- Highmark Health (Topeka, KS)
- …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
- CVS Health (Topeka, KS)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Oracle (Topeka, KS)
- …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