- Humana (Providence, RI)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Cognizant (Providence, RI)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Hartford HealthCare (Mansfield Center, CT)
- …Professionals* **Organization:** **Hartford HealthCare at Home* **Title:** *Hospice Aide Clinical Supervisor (LPN, LVN, Licensed Practical Nurse )* **Location:** ... part of Connecticut's most comprehensive healthcare network as an HomeCare Aide Clinical Supervisor. Hartford HealthCare at Home, the largest provider of homecare… more
- CVS Health (Woonsocket, RI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Dana-Farber Cancer Institute (Foxborough, MA)
- …Director of Nursing is responsible for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care ... the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and… more
- Evolent (Providence, RI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Edwards Lifesciences (Providence, RI)
- …post-case management , 3 Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and educational ... and implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience + Current CPR certification. Benefits: + Competitive salary based on related ... to support this growth. We are currently hiring a Clinical Care Manager based in Milford, MA. The ...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who… more
- Fallon Health (Worcester, MA)
- …Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
- Hartford HealthCare (Mansfield Center, CT)
- …degree in PT, OT, SLP preferred 2 years as certified home health clinical management or OASIS reviewer Homecare Homebase experience required OASIS Certification ... and/or Quality/Compliance Certification 3 years as certified home health clinical management or OASIS reviewer preferred We take great care of careers With… more
- Charter Care Health Partners (North Providence, RI)
- …Continuum of Care Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the ... residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical...clinical experience that includes recent experience with case management , patient navigation, case management , utilization… more
- Charter Care Health Partners (North Providence, RI)
- …Continuum of Care Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the ... residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical...clinical experience that includes recent experience with case management , patient navigation, case management , utilization… more
- Oracle (Providence, RI)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Highmark Health (Providence, RI)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more