- Humana (Olympia, WA)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- University of Washington (Seattle, WA)
- …) **UW Medical Center** has an outstanding opportunity for an **experienced Utilization Review Nurse (UM RN)** to join our ... Req #: 236354 Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT Job Location Detail: Position...training + Active licensure to practice as a Registered Nurse in Washington State required by start date +… more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse ...Or + Associate's Degree Nursing + 3 years of Utilization Review , Care Management , Quality ... a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination.… more
- Centene Corporation (Olympia, WA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Molina Healthcare (Seattle, WA)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- …are determined by VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... by supervisors. Duties include but not limited to: Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrates leadership in delivering and improving holistic… 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 ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Molina Healthcare (Seattle, WA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Evolent (Olympia, WA)
- …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
- CenterWell (Silverdale, WA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Virginia Mason Franciscan Health (Seattle, WA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and ... located within hospital + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred + Bachelor's Degree in Nursing… more
- Evolent (Olympia, WA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Providence (Olympia, WA)
- …+ Within 3 years of hire Care Manager Certification + 1 year of Care management , discharge planning, or utilization management experience in the acute, ... time **Job Shift:** Multiple shifts available **Career Track:** Nursing **Department:** 3030 UTILIZATION REVIEW WA PSPH OLYMPIA MAIN 2ND FLOOR QUALITY OFFICES… more
- Virginia Mason Franciscan Health (Gig Harbor, WA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Education and...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Education and...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Virginia Mason Franciscan Health (Gig Harbor, WA)
- …regional basis; 2) developing/overseeing a regional length-of-stay multi-disciplinary team (eg care management , utilization review , finance, etc.); and 3) ... Center model for ensuring the timely, efficient and cost-effective utilization of bed resources on a regional basis. Work...facilities. Job duties require the services of a Registered Nurse who, based on training and work experience, uses… more
- Molina Healthcare (Seattle, WA)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more