- CenterWell (Madison, WI)
- …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 (Madison, WI)
- **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
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …management , business architecture management , partnership management , requirements management , and change management . The Nurse Deputy Health ... in the following core informatics functions to include content management , application support, health information technology system optimization, enterprise data… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …, business architecture management , partnership management , requirements management , and change management . The Nurse Informaticist Registered ... Demonstrates the following core informatics functions to include content management , application support, health information technology system optimization, enterprise… more
- Molina Healthcare (Madison, WI)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care. The Registered Nurse - ... EDRP application. Former EDRP participants ineligible to apply. Responsibilities This Registered Nurse - Community Living Center (CLC) position is located at the… more
- Molina Healthcare (Madison, WI)
- …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
- Evolent (Madison, WI)
- …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
- Intermountain Health (Madison, WI)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Humana (Madison, WI)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Fresenius Medical Center (Madison, WI)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Fresenius Medical Center (Fitchburg, WI)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Select Medical (Madison, WI)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... $10,000 Sign On Bonus **_Clinical license as a registered nurse or respiratory therapist or master's in social work...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more
- Molina Healthcare (Madison, WI)
- …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
- Select Medical (Madison, WI)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- SSM Health (Madison, WI)
- …opportunities for improvement in standard work. + May also be responsible for: utilization management process, ED case management process, admission process, ... described in the department's Scope of Service. + As an SSM Health nurse , I will demonstrate the professional nursing standards defined in the professional practice… more
- Highmark Health (Madison, WI)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- Molina Healthcare (Madison, WI)
- …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
- Molina Healthcare (Dane, WI)
- …follows-up as necessary. * Identifies gaps in acute/primary care and chronic disease management . * Identifies medical risk and collaborates with members of the care ... * Provides consultation as needed, for medically complex members and/or high utilization members (eg, palliative care, dementia, psychiatric). * Engages in practices… more
- Sharecare (Madison, WI)
- …/ 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