- CVS Health (Olympia, WA)
- …1 holiday per year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... we do it all with heart, each and every day. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote but must reside in… more
- CenterWell (Olympia, WA)
- …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 (Olympia, WA)
- **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
- Molina Healthcare (Tacoma, WA)
- …key health care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. ... professionals, in some or all of the following functions: utilization management , care management , care...and experience. * At least 5 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- Elevance Health (Seattle, WA)
- ** Utilization Management Representative II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... AM and 5:00 PM Pacific. The **Behavioral Health (BH) Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Providence (Olympia, WA)
- …a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. ... + Bachelor's Degree or Associate's Degree in Nursing + 3 years - Utilization Review, Care Management , Quality Management , and/or Discharge planning… more
- Defense Health Agency (Tacoma, WA)
- …appropriate priorities; responsiveness to emergencies; effectiveness of practice, patient management , bed utilization ; customer service and relations; open ... **Overview** ** NURSE (Labor and Delivery), Tacoma, WA** **This position...throughout hospitalization g. Participates in Quality Improvement, Internal Control Management Program, and Utilization Training. Provides neonatal… more
- CVS Health (Olympia, WA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Elevance Health (Seattle, WA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Virtual:** This role enables associates...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- General Dynamics Information Technology (Lakewood, WA)
- …a case manager by a recognized certifying organization, ie Commission for Case Management Certification or American Nurse Credentialing Center. + Current RN ... Yes **Job Description:** Seize your opportunity to make a personal impact as Nurse Case Manager supporting mission critical work on an exciting program. GDIT is… more
- University of Washington (Seattle, WA)
- …least one of the following: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare ... Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE + 100% Remote + Days **POSITION… more
- Molina Healthcare (Tacoma, WA)
- …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
- Molina Healthcare (Shelton, WA)
- …post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings ... states besides home state based on business need. * Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and… more
- Sea Mar Community Health Centers (Seattle, WA)
- …assist providers in procedures. + Facilitate emergency referrals according to the utilization management guidelines when the referral coordinator is unavailable. ... to patients who have yet to be seen. Responsible for management of nurse visit encounters. These will include fast-track immunizations; annual employee… more
- Evolent (Olympia, WA)
- …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
- University of Washington (Seattle, WA)
- …has an outstanding opportunity for an experienced acute care Nurse Manager to work on our **Cardiology/Cardiothoracic unit.** **DEPARTMENT DESCRIPTION** ... best practices + Monitor patient flow, throughput, and resource utilization to maintain efficiency in a fast-paced hospital environment...Nursing + Active licensure to practice as a Registered Nurse in Washington State + 6 years of clinical… more
- Molina Healthcare (Tacoma, WA)
- …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
- Providence (Olympia, WA)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation ... **Description** The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehensive, patient...specialty upon hire. + 1 year experience in care management or utilization review in any setting… more
- Providence (Olympia, WA)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation ... **Description** The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehensive, patient...area of specialty. + 1 year experience in care management or utilization review in any setting… more
- CenterWell (Silverdale, WA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more