- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Providence, RI)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Hartford HealthCare (Willimantic, CT)
- …**Title:** *Registered Nurse Case Manager (RN) - Utilization Management * **Location:** *Connecticut-Willimantic-Windham Community Memorial (10183)* ... resources. Works under the direction of the Manager of Continuing Care and Utilization Management and in collaboration with physicians, social services, and… more
- CVS Health (Woonsocket, RI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Evolent (Providence, RI)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Hartford HealthCare (Norwich, CT)
- …the following activities: * Provides staff guidance in making clinical and case management decisions focused on clinical excellence for end of life care and symptom ... management . Directs staff in the Medicare Hospice Benefit guidelines...clinical software to identify opportunities for education, most appropriate utilization of services, oversee clinical progression of patients and… more
- Hartford HealthCare (Norwich, CT)
- …balance. Every moment matters. And this is*your moment.* **Job:** ** Management * **Organization:** **Backus Hospital* **Title:** *Assistant Nurse Manager ... more about you! *JOB SUMMARY* The Assistant Nursing manager is a Registered Nurse (RN) who has responsibility for the supervision of patient care, clinical… more
- UCFS Healthcare (Norwich, CT)
- Per Diem Primary Care Nurse -RN/LPN Norwich, CT (http://maps.google.com/maps?q=47+Town+Street+Norwich+CT+USA+06360) Job Type Part-time Description UCFS is looking for ... the lives of others!We are currently seeking apart-time (per diem 16hrs) Nurse , RN/LPNwho will utilize critical thinking skills to interpret complex information in… more
- UCFS Healthcare (Norwich, CT)
- Pediatric Walk-In Center Nurse -RN/LPN Norwich, CT (http://maps.google.com/maps?q=47+Town+Street+Norwich+CT+USA+06360) Job Type Part-time Description UCFS is looking ... the lives of others!We are currently seeking apart-time (per diem 10hrs) Nurse , RN/LPNwho will utilize critical thinking skills to interpret complex information in… more
- Hartford HealthCare (Norwich, CT)
- …balance. Every moment matters. And this is*your moment*. **Job:** ** Management * **Organization:** **Backus Hospital* **Title:** *Assistant Nurse Manager ... of our communities. *JOB SUMMARY* The Assistant Nursing manager is a Registered Nurse (RN) who has responsibility for the supervision of patient care, clinical… more
- Evolent (Providence, RI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Fresenius Medical Center (Providence, RI)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Hartford HealthCare (Mansfield Center, CT)
- …including implementation, follow-through, and competency validation- in collaboration with Care Management and Quality teams. Oversees hospice care aide staffing to ... ensure appropriate resource utilization and meet client needs; manages hiring, scheduling, training,...supervisory home visits and development planning. Collaborates with Care Management and Quality teams to develop annual in-service programs;… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Hartford HealthCare (Mansfield Center, CT)
- …individual in this role provides clinical staff with guidance on documentation, utilization , and patient care decisions to support optimal clinical and operational ... outcomes. They review visit utilization for care appropriateness and collaborate with clinicians on...accredited educational program leading to licensure as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), or… more
- Sharecare (Providence, RI)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Providence, RI)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Woonsocket, RI)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Edwards Lifesciences (Providence, RI)
- …an impact:** + Working independently in the areas of valve crimping, case management , pre-case planning, post-case management , 3 Mensio management , Therapy ... implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential customers… more