- Elevance Health (Richmond, VA)
- **Title: Utilization Management Representative II** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The ** Utilization Management Representative II** will be responsible...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles… more
- Elevance Health (Richmond, VA)
- **Title: Utilization Management Representative I** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of our ... PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- HCA Healthcare (Richmond, VA)
- …concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan + As a member of Case Management team ... Graduate of an accredited school of nursing. + Commercial Utilization Management and/or Case Management ...encourage you to apply for our Case Manager Registered Nurse RN PRN opening. We review all… more
- ChenMed (Richmond, VA)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Elevance Health (Richmond, VA)
- **Medical Management Nurse ** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, ... pm (EST) shift rotation twice a month.** The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- HCA Healthcare (Richmond, VA)
- …in 21 states and the United Kingdom. We are looking for a(an) assistant Nurse Manager Patient Logistic Center for our HCA Healthcare team where excellence creates ... you want to be an influencer in healthcare? **Apply for our assistant Nurse Manager Patient Logistic Center role today!** **Job Summary and Qualifications** +… more
- Elevance Health (Richmond, VA)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Bon Secours Mercy Health (Richmond, VA)
- …an environment where associates want to work and help communities thrive. **Registered Nurse (RN) - Physician Office - Bon Secours - Cardiology, Reynolds - Richmond, ... step down or critical care experience as a Registered Nurse + Experience within a physician practice setting. +...format and content of patient records. + Ability to review records, read physician documentation and verify patient identification.… more
- Molina Healthcare (Charlottesville, VA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... For this position we are seeking a (RN) Registered Nurse or LCSW who lives in VIRGINIA and must...years in one or more of the following areas: utilization management , case management , care… more
- Evolent (Richmond, VA)
- …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
- Highmark Health (Richmond, VA)
- …Highmark Health **Job Description :** **JOB SUMMARY** 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
- HCA Healthcare (Richmond, VA)
- …through clinical screenings and assessments in collaboration with both hospital Case Management and the Rehab Medical Director and works closely with hospital case ... management to ensure a responsive and smooth flowing referral...prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong clinical… more
- Humana (Richmond, VA)
- …preventative care and assist with appointment and transportation scheduling as necessary * Review EPSDT services and assessments and HEDIS data to identify gaps in ... care and targeted interventions to increase utilization of well-child visits, exams, screenings and services * Conducts medical record reviews of providers working… more
- Evolent (Richmond, VA)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + Cardiology and Oncology ... identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases for Care … more