- Humana (Little Rock, AR)
- **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
- Baylor Scott & White Health (Little Rock, AR)
- …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....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Highmark Health (Little Rock, AR)
- …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
- Sharecare (Little Rock, AR)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Little Rock, AR)
- …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
- CVS Health (Little Rock, AR)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- CVS Health (Little Rock, AR)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews **Required Qualifications** + 5+ years' experience as a Registered Nurse with hospital experience; preferably in...lower levels of care + 1+ years' experience in Utilization Review + CCM and/or other URAC… more
- Guardian Life (Little Rock, AR)
- …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
- Catholic Health Initiatives (Little Rock, AR)
- …CCM or ACM Certification within 2 years of hire date + Previous case management , utilization management , or discharge planning experience strongly preferred ... **Overview** As a Case Manager Nurse with CHI St Vincent Infirmary, you'll work...CHI St Vincent Infirmary, you'll work with physicians, other registered nurses, specialized departments, and community resources. This provides… more
- Evolent (Little Rock, AR)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Arkansas Children's (Little Rock, AR)
- …with planning, implementing and evaluating the strategic goals of the utilization management program. Oversees staff that process referrals, authorizations, ... billing, utilization review , and capitation for hospital services...services and assists in the daily operation of the discharge/ utilization management department. Has some authority for… more