- CVS Health (Indianapolis, IN)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Indianapolis, IN)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Indianapolis, IN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for...with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and… more
- Centene Corporation (Indianapolis, IN)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, ... including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance… more
- Evolent (Indianapolis, IN)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Indianapolis, IN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Clarksville, IN)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Elevance Health (Indianapolis, IN)
- …minimum of 4 years managed care experience and requires a minimum of 2 years clinical , utilization review, or case management experience; or any combination ... **Medical Management Nurse ** **Hours: Candidates will work...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- Fresenius Medical Center (Noblesville, IN)
- Sign-On Bonus Available **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while ... maintaining clinical operations. As the facility leader, you will be...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Elevance Health (Indianapolis, IN)
- …granted as required by law. ** Must be an Indiana resident ** The **Medical Management Nurse ** is responsible for review of the most complex or challenging cases ... Director on particularly peculiar or complex cases as the nurse deems appropriate. + May make recommendations on alternate... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience;… more
- CVS Health (Indianapolis, IN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Trinity Health (Mishawaka, IN)
- …The inpatient **Certified Wound Ostomy Continency Consultant (CWOCN Consultant), Registered Nurse ** will provide clinical oversight and coordination for ... support and staff development activities that provide the bedside nurse with the knowledge, skills, and confidence to manage...and their family members to assist them in the management of their individual wound care needs. Ultimate responsibility… more
- Veterans Affairs, Veterans Health Administration (Indianapolis, IN)
- …collaboration with PACT team to ensure continuum of care and optimal utilization of healthcare resources. 19. Completes nursing clinical reminders thoroughly ... the Richard L. Roudebush VAMC, IN within the Primary Care service. The Licensed Practical Nurse works under the direction of an RN and reports to the primary care… more
- International Medical Group (Indianapolis, IN)
- …large case management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for large case management ... reading materials, online courses and/or seminars. + Support and participate in Quality Management activities. + Utilize clinical support tools as indicated. +… more
- Trinity Health (Mishawaka, IN)
- …by assignment. Minimum five (5) years of equivalent experience in health condition management in an adult acute care clinical setting with direct patient ... This is NOT a remote position.** **_About the job:_** The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in… more
- CVS Health (Indianapolis, IN)
- …8:00am - 5:00pm in time zone of residence **Preferred Qualifications** - Utilization Management review - Managed Care experience **Education** Associates degree ... each and every day. **Position Summary** As a QM Nurse Consultant you will be responsible for the review...will be responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets… more
- Elevance Health (Indianapolis, IN)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Humana (Indianapolis, IN)
- **Become 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 ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more