- CVS Health (Olympia, WA)
- …1 holiday per year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... we do it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in… more
- CenterWell (Olympia, WA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Olympia, WA)
- **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
- Molina Healthcare (Tacoma, WA)
- …key health care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. ... professionals, in some or all of the following functions: utilization management , care management , care...and experience. * At least 5 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- Providence (Olympia, WA)
- …a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. ... + Bachelor's Degree or Associate's Degree in Nursing + 3 years - Utilization Review, Care Management , Quality Management , and/or Discharge planning… more
- Defense Health Agency (Tacoma, WA)
- …appropriate priorities; responsiveness to emergencies; effectiveness of practice, patient management , bed utilization ; customer service and relations; open ... **Overview** ** NURSE (Labor and Delivery), Tacoma, WA** **This position...throughout hospitalization g. Participates in Quality Improvement, Internal Control Management Program, and Utilization Training. Provides neonatal… more
- General Dynamics Information Technology (Lakewood, WA)
- …a case manager by a recognized certifying organization, ie Commission for Case Management Certification or American Nurse Credentialing Center. + Current RN ... Yes **Job Description:** Seize your opportunity to make a personal impact as Nurse Case Manager supporting mission critical work on an exciting program. GDIT is… more
- Molina Healthcare (Tacoma, WA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Shelton, WA)
- …post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings ... states besides home state based on business need. * Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and… more
- Evolent (Olympia, WA)
- …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
- Fresenius Medical Center (Bonney Lake, WA)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Molina Healthcare (Tacoma, WA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Providence (Olympia, WA)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation ... **Description** The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehensive, patient...specialty upon hire. + 1 year experience in care management or utilization review in any setting… more
- Providence (Olympia, WA)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation ... **Description** The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehensive, patient...area of specialty. + 1 year experience in care management or utilization review in any setting… more
- CenterWell (Kent, WA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Virginia Mason Franciscan Health (Gig Harbor, WA)
- …Collaboration:** You'll collaborate with a multi-disciplinary team (eg, care management , utilization review, finance) to address patient flow/bed ... Summary and Responsibilities** Are you a highly skilled and dynamic Registered Nurse with a passion for critical thinking and ensuring seamless patient transitions?… more
- Molina Healthcare (Tacoma, WA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of… more
- Sharecare (Olympia, WA)
- …/ 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
- Virginia Mason Franciscan Health (Enumclaw, WA)
- …of available standards, resources and data, and in the efficient utilization of staff/resources. Work involves continuous contact with physicians, patients, patient ... families, community agencies, patient care staff and management . An incumbent is accountable for the quality of...ED residency program, required. Licensure and Certifications: + Registered Nurse : WA (RN:WA) - required upon hire + Basic… more
- Virginia Mason Franciscan Health (Enumclaw, WA)
- …of available standards, resources and data, and in the efficient utilization of staff/resources. Work involves continuous contact with physicians, patients, patient ... families, community agencies, patient care staff and management . An incumbent is accountable for the quality of...the ED residency program required. **License and Certifications:** Registered Nurse : WA (RN:WA) required upon hire Basic Life Support… more