- CVS Health (Pierre, SD)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CenterWell (Pierre, SD)
- …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 (Pierre, SD)
- **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
- Evolent (Pierre, SD)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… 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...the patient. + Makes recommendations for efficient and effective utilization of resources to achieve positive outcomes by implementing… more
- Avera (Pierre, SD)
- …both clinically and administratively. As the off shift representative of management , supervises staff and makes administrative decisions, which may involve patients ... personnel/patient issues in the absence of clinical leaders. + Coordinates utilization of resources including staff, ancillary staff, equipment and facilitates… more
- Sharecare (Pierre, SD)
- …/ 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
- 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 ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- STG International (Pierre, SD)
- …to ensure compliance and patient safety. *Participates in quality improvement, care management , risk management , peer review, utilization review, clinical ... in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership to CBOC clinicians. *Evaluate the effectiveness of… 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 ... 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
- GE Aerospace (Pierre, SD)
- …does not directly own infrastructure platforms. The role accelerates digital utilization by standardizing data models, establishing reusable patterns, ensuring high ... data models, semantic layers, and reusable transformation patterns. **Data Management and Governance** + Implement data governance with domain-aligned stewardship,… more
- Oracle (Pierre, SD)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more