- Trinity Health (Springfield, MA)
- …program. BSN graduate preferred, Master's preferred + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS ... criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization ... Nurse , ICC and Social Worker with utilization management and clinical coordination of the… more
- Trinity Health (Stafford Springs, CT)
- …affiliated nursing program. BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in Connecticut. + **Certification** : BLS ... **Shift:** Day Shift **Description:** At **Johnson Memorial** **Hospital** the **Case Management Department** we provide quality care for patients by organizing… more
- Fresenius Medical Center (Springfield, MA)
- …Director. + Plans, coordinates and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of ... member eligibility. Facilitate timely workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as… more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse uses behavioral health knowledge and ... be located and licensed in a Compact State** The Utilization Management Behavioral Health Nurse ...Qualifications** + Minimum of Associate Degree in Nursing + Registered Nurse ( RN ) licensure with… more
- CVS Health (Hartford, CT)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... include weekends and holidays and evening rotations. As a Utilization Management Nurse Consultant, you...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
- Humana (Hartford, CT)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license… more
- The Cigna Group (Bloomfield, CT)
- …duties as assigned. **Qualifications** + Education: Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) + 3-5 years' experience in Medicare Advantage ... limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare...a minimum of 18 days of paid time off per year and paid holidays. For more details on… more
- Evolent Health (Hartford, CT)
- …driving results, and collaborating with others. **Collaboration Opportunities** : The Lead Nurse of Utilization Management is responsible for assisting ... the UM Manager in supervising the operational productivity of the Utilization Management nurses by implementing and maintaining an efficient and effective flow… more
- The Cigna Group (Bloomfield, CT)
- …history of effective case load management .** **Minimum Requirements:** **Active** **Unrestricted Registered ** ** Nurse ( RN ) license in state or territory ... ** Nurse Case Management Lead Analyst -Remote...and assigning to a client based CM for further management when appropriate.** **Must be skilled in utilization… more
- Humana (Hartford, CT)
- … RN , Compliance Nurse 2, Quality Assurance Auditor reviews utilization management activities and documentation to ensure adherence to policies, ... an acute care, skilled and/or rehabilitation clinical setting + Experience with utilization management , pre-service denials and/or quality assurance audits +… more
- Elevance Health (Wallingford, CT)
- ** RN Hospital Bill Audit/Appeal Lead** **Supports the Carelon Payment Integrity line of business** _Location: This position will work a hybrid model (remote and ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** RN Hospital Audit/Appeal Lead** is responsible for leading a team of… more
- The Cigna Group (Bloomfield, CT)
- …and reimbursement for multiple Therapeutic Resource Centers. **QUALIFICATIONS** + Active, unencumbered Registered Nurse ( RN ) license in Pennsylvania + High ... Nurse Clinician - Accredo Job Description Summary The Nurse Clinician - RN is responsible for...providers, members and patient client advocates within the Prior Authorization/ Utilization Management department. Identify and track trends… more
- University of Connecticut (UConn) (Storrs, CT)
- …verbal, and/or telephone orders directing the patient medical regimen for execution by the registered nurse per Public Act No.03-8. + Participates in various ... (MH), is seeking applicants for a Psychiatric Advanced Practice Registered Nurse (APRN) for the position of...clinical practice, performing acts of diagnoses and health care management as described in Public Act 99-168; interacting with… more
- CVS Health (Hartford, CT)
- …expense reimbursement policy. Preferred Qualifications : Oklahoma residency preferred Oklahoma-licensed registered nurse preferred OR be certified as a Certified ... a variety of external and internal audiences including senior management . Required Qualifications : * 5 to 7 years'...(CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment. A minimum of… more
- The Cigna Group (Bloomfield, CT)
- …and specialist appointment scheduling. . Provide clinical assessments, health education, and utilization management to customers, as needed. . Initiate contact ... team. . Other duties as assigned. **Qualifications** : . Active and Unencumbered Compact Registered Nurse licensure required . A minimum of three or more years… more
- The Cigna Group (Bloomfield, CT)
- …and specialist appointment scheduling. + Provide clinical assessments, health education, and utilization management to customers, as needed. + Initiate contact ... issues to the appropriate team. + Other duties as assigned. **Qualifications** : + Registered Nurse with 1-2 years related experience and/or training in Case … more
- Moses/Weitzman Health System (New Britain, CT)
- …professional organizations. + Minimum of one year prior experience as an advanced practice registered nurse + As a condition of employment, CHC requires current ... in meeting patients' health care needs + Participates with CHCI management in developing and achieving optimal clinical performance and organizational goals… more
- The Cigna Group (Bloomfield, CT)
- …+ Behavioral Telephonic Consultation + Confide Services Assessment + Brief Case Management + Utilization Management **Duties and Responsibilities:** + ... **Full time job with a minimum of forty hours per week five days a week. Shift days and...will help customers navigate the mental health system, including utilization of benefits and accessing direct care services. As… more
- Humana (Hartford, CT)
- …Skilled Nursing Facility) Operations + Experience with Post Acute Care Services network management and/or utilization management + Experience with Post Acute ... of variable factors and determining the best course of action. + **Portfolio management ** - Assisting the leadership team to help ensure strategic alignment across… more