- Elevance Health (Richmond, VA)
- …work-life integration, and ensures essential face-to-face onboarding and skill development._ The ** Medical Management Clinician Sr** is responsible for ... types that require the training and skill of a registered nurse . Acts as a resource for...efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- CVS Health (Richmond, VA)
- …all with heart, each and every day. **Position Summary:** This Case Manager Registered Nurse /Behavioral Health Clinician position is with Aetna's Long-Term ... The requirements is for candidates to hold an VA Registered Nurse and travel up to 75%...responsible for assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical… more
- Highmark Health (Richmond, VA)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of… more
- Oracle (Richmond, VA)
- …. **Requirements:** + **Licensed clinician (Physician, Advanced Practice Provider, Registered Nurse )** + Extensive knowledge across multiple Oracle Health ... and AI capabilities. Facilitate Value Measurement and outcomes across the clinician experience and quality metrics for targeted customer initiatives and… more
- Datavant (Richmond, VA)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus. Minimum… more
- Elevance Health (Richmond, VA)
- ** Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... service members in different states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the… more
- Humana (Richmond, VA)
- …and drive execution without day-to-day oversight **Preferred Qualifications** + Background as a clinician ( RN , NP, PA, MD, PharmD, or similar) + Experience with ... to execution. The Lead Product & Strategy Manager - Provider Practice Management role is a critical member of the multidisciplinary clinical initiatives team… more
- Oracle (Richmond, VA)
- **Job Description** Oracle Health is standing up a specialized clinical product management team focused on medical device-aligned products. This team bridges ... awareness and readiness across the broader product organization. Qualifications Required: . Licensed clinician ( RN , PharmD, MD, NP, PA, or equivalent) with 5+… more
- Oracle (Richmond, VA)
- **Job Description** Oracle Health is standing up a specialized clinical product management team focused on medical device-aligned products. This team bridges ... awareness and readiness across the broader product organization. Qualifications Required: . Licensed clinician ( RN , PharmD, MD, NP, PA, or equivalent) with 5+… more
- Bon Secours Mercy Health (Richmond, VA)
- …Reports: 0 **Primary Function/General Purpose of Position** The Informatics Nurse Specialist coordinates and monitors the analysis, design, implementation, ... subordinate group. + Develops and performs competency assessments related to clinician use of information systems, documents findings; designs and delivers targeted… more
- Humana (Richmond, VA)
- …a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to… more