- Humana (Honolulu, HI)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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
- Highmark Health (Honolulu, HI)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Highmark Health (Honolulu, HI)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Guardian Life (Honolulu, HI)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Centene Corporation (Honolulu, HI)
- …of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN Licensed - State ... findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and… more
- Always Best Care Senior Services (Honolulu, HI)
- …personnel records, and company financial records, which may be discussed with all management staff. QUALIFICATIONS 1. Registered Nurse licensed in the ... or services (with complete cost/benefit analysis). Oversees all CQI and utilization review activities. Assists in agency evaluation activities. Participates… more
- Always Best Care Senior Services (Honolulu, HI)
- …are met. Additional responsibilities: * Develops a process to monitor appropriate utilization of services. * Directs the implementation of service goals and ... provides leadership in peak periods * Monitors clinical record review process. Case coordination oversight. * Develops plan for...a Medicare Home Health environment, hold a current APRN, RN license in the state of employment, and have… more