- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 240830-5613FP-001 Location Middletown, CT Date Opened 9/5/2024 12:00:00 AM Salary ... Hospital - is accepting applications for one (1) full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Lincoln Financial Group (Hartford, CT)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Sedgwick (Hartford, CT)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital...RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical bills from providers including… more
- Hartford HealthCare (Torrington, CT)
- …Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP ... Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other… more
- The Cigna Group (Bloomfield, CT)
- …preferred + 5+ years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency with Microsoft Office ... Nurse Case Management Lead Analyst- Nurse Clinician...years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency… more
- Baystate Health (Springfield, MA)
- **Position** Licensed Practical Nurse **SCHEDULE:** + Full time + Monday - Friday + No weekends no holidays **LOCATION** : + Springfield, MA The Licensed Practical ... Nurse (LPN) functions under the supervision and guidance of...support to the patient's primary care team regarding patients' utilization management needs. The Clinical Utilization Reviewer… more
- Prime Therapeutics (Hartford, CT)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Baystate Health (Springfield, MA)
- …facility/program, emergency room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that is pending, ensure ... required and is vital. Care management program metrics including, emergency room utilization , and hospital admission/readmission data will be reviewed on a regular… more
- CVS Health (Hartford, CT)
- …**Preferred Qualifications** + Appeals Experience + Managed Care Experience + Utilization review experience + Proficiency with computer skills including ... 8a-5p in time zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data… more
- Fresenius Medical Center (Springfield, MA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (West Springfield, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Elevance Health (Wallingford, CT)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more
- Highmark Health (Hartford, CT)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Hartford HealthCare (West Hartford, CT)
- …- *Stroke GOLD PLUS Achievement Award winner* in 2016. *Physician Assistant or Nurse Practitioner (APRN) Role Scope* Along with practicing as a full time, clinical ... meets with their teams routinely (monthly) to provide updates, review areas for improvement, and listen and respond to...coordinating scheduling. Assists in determining suitability for team member utilization of PTO and CME excused time. . Assists… more
- Baystate Health (Springfield, MA)
- …and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers ... 16 hours** The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality,...for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other… more
- Baystate Health (Springfield, MA)
- The **ACO Nurse Care Manager i** s responsible for the management of care for a defined group of patients including complex care management, transitions of care, as ... facility/program, emergency room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that is pending, ensure… more
- Masonicare (Wallingford, CT)
- …staff, prepares on-call schedules, plans and organizes daily assignments including the review and assignment of new patient referrals. + Supervises all assigned ... reviews to assess the appropriateness of care plan, the utilization of services and to ensure complete documentation of...by the American Nurses' Association as a community health nurse or completion of at least six credits received… more
- Baystate Health (Springfield, MA)
- …ensure coordination of services for patients, providers, Practice Managers/Supervisors/ Nurse Managers Responsibilities include ensuring adequate assignments of ... include building, monitoring, coaching, and reporting BMP practice schedule utilization to leadership. **JOB REQUIREMENTS** 1) Creates complex multidisciplinary… more
- Baystate Health (Springfield, MA)
- …and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers ... Full Time** The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality,...for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other… more
- The Cigna Group (Bloomfield, CT)
- …other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to ... and organizational skills; effectively manage competing priorities and multiple deadlines. + Review , research and understand how request for plan services and claims… more