- Humana (Madison, WI)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Molina Healthcare (Madison, WI)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Humana (Madison, WI)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Fresenius Medical Center (Baraboo, WI)
- …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
- Molina Healthcare (Madison, WI)
- …with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. WI or COMPACT RN LICENSURE IS REQUIRED within 30 days of employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical to PA is preferred._** **_Excellent computer skills and attention to detail are very… more
- Molina Healthcare (Madison, WI)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Evolent (Madison, WI)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Evolent (Madison, WI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Intermountain Health (Madison, WI)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more
- Molina Healthcare (Madison, WI)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more