- 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 supports both...training + Active licensure to practice as a Registered Nurse in Washington State required by start date +… more
- 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 the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...of the appropriate courses of action. You will be part of a caring community at Humana. When you… more
- Elevance Health (Seattle, WA)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- Molina Healthcare (Seattle, WA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Evolent (Olympia, WA)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … 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 ... **Become a part of our caring community and help us...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Evolent (Olympia, WA)
- …a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part ... focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and procedures… more
- Providence (Olympia, WA)
- …time **Job Shift:** Multiple shifts available **Career Track:** Nursing **Department:** 3030 UTILIZATION REVIEW WA PSPH OLYMPIA MAIN 2ND FLOOR QUALITY OFFICES ... and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to… more