- CVS Health (Pierre, SD)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Pierre, SD)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CenterWell (Pierre, SD)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Pierre, SD)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Pierre, SD)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Avera (Gregory, SD)
- …where you matter.** **A Brief Overview** Responsible for the care planning, utilization of services, coordination of care, and the education of the interdisciplinary ... teams in the management of patient care services. Develops all patient care...do** + Functions as interventionalists in the home utilizing clinical expertise and problem solving to make recommendations to… more
- Avera (Pierre, SD)
- …volume, identify and manage any personnel/patient issues in the absence of clinical leaders. + Coordinates utilization of resources including staff, ancillary ... Upon Hire **Preferred Education, License/Certification, or Work Experience:** + 1-3 years clinical experience as RN + supervisory or management experience… more
- STG International (Pierre, SD)
- …and patient safety. *Participates in quality improvement, care management , risk management , peer review, utilization review, clinical outcomes, and ... into the VA health care system. *Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership… more
- Datavant (Pierre, SD)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Sharecare (Pierre, SD)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Pierre, SD)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Highmark Health (Pierre, SD)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more