- Humana (Honolulu, HI)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (Honolulu, HI)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff.... management , and budget control. Departments involved are Utilization Management , Case Management , and… more
- Centene Corporation (Honolulu, HI)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN Licensed… more
- Fresenius Medical Center (Honolulu, HI)
- …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
- Evolent (Honolulu, HI)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Evolent (Honolulu, HI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Always Best Care Senior Services (Honolulu, HI)
- …or services (with complete cost/benefit analysis). Oversees all CQI and utilization review activities. Assists in agency evaluation activities. Participates ... personnel records, and company financial records, which may be discussed with all management staff. QUALIFICATIONS 1. A Registered Nurse licensed in the state… more