- Humana (Richmond, VA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CVS Health (Richmond, VA)
- …state of residence. 1+ years of clinical experience **Preferred Qualifications** Utilization Management experience Managed Care Experience Proficiency in grammar ... services. Maintains accurate and complete documentation to meet risk management , regulatory, and accreditation requirements. Promotes communication, both internally… more
- CenterWell (Richmond, VA)
- …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 (Richmond, VA)
- **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
- ChenMed (Richmond, VA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment… 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...living through a comprehensive residential rehabilitation program focusing on home , community, vocational re-integration for Veterans and Active-Duty Service… more
- Evolent (Richmond, VA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Bon Secours Mercy Health (Richmond, VA)
- … certification (CCM) (preferred) **Minimum Qualifications** 2-3 years acute care, home health or case management experience (required) **Other Knowledge, ... excellence. **Summary of Primary Function** In the capacity of a Registered Nurse (RN), the Ambulatory Care Manager will provide clinical care management… 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
- ChenMed (Colonial Heights, VA)
- …informed decisions re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and reimbursement for ... occasionally in acute care, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment. The responsibilities include… more
- HCA Healthcare (Richmond, VA)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Chippenham… more
- Sharecare (Richmond, VA)
- …/ 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
- HCA Healthcare (Richmond, VA)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity… more