- CVS Health (Richmond, VA)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Richmond, VA)
- …help us put health first** Full-Time, Remote Telephonic opportunity 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
- Humana (Richmond, VA)
- …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
- CenterWell (Richmond, VA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CVS Health (Richmond, VA)
- …, with an unrestricted license in state of residence. 1+ years of clinical experience **Preferred Qualifications** Utilization Management experience Managed ... services. Maintains accurate and complete documentation to meet risk management , regulatory, and accreditation requirements. Promotes communication, both internally… more
- Evolent (Richmond, VA)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Richmond, VA)
- …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
- Bon Secours Mercy Health (Mechanicsville, VA)
- …observation experiences throughout the program. The educators, along with preceptor and Nurse Directors, assess each participant's clinical progression to match ... and partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate,… more
- ChenMed (Richmond, VA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to ... our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... Summary The Registered Nurse - Polytrauma Transitional Rehabilitation Program (PTRP) at...of the rationale for care processes and decisions. Questions clinical practices for the purpose of providing evidence-based care.… 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
- ChenMed (Colonial Heights, VA)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required. The PCP ... who plays a key role as part of the clinical operations team providing direct patient care and providing...re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and… 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
- Elevance Health (Richmond, VA)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Bon Secours Mercy Health (Richmond, VA)
- …of a Registered Nurse (RN), the Ambulatory Care Manager will provide clinical care management services to identified eligible patients; coordinating care to ... cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function** In the capacity… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Registered Nurse (RN)...and assessment of individuals in need of active Case Management services and promotes the right resources, at the… more
- Bon Secours Mercy Health (Richmond, VA)
- …cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Job Description **Registered Nurse (RN) - ... and partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate,… 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 ... Commonwealth of Virginia is required. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Requires HS diploma or… more
- ChenMed (Colonial Heights, VA)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other programs that maximize and ... ( _with the support of the Care Team and Nurse Practitioner/Physician Assistant depending on ratio_ ). + Assesses...practices and procedures within the Cardiology field + Superior clinical skills in the management of seniors… more
- HCA Healthcare (Richmond, VA)
- …of Employee Health Nurse during non-business hours, as needed. + Manages clinical projects and serves on hospital committees as assigned. + Provides input into ... shape business and operational outcomes, or work to deliver clinical excellence behind the scenes in data science, case... excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Chippenham… more