- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Hartford, CT)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Fresenius Medical Center (Bristol, CT)
- …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
- Highmark Health (Hartford, CT)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Hartford, CT)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Hartford, CT)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour)...+ + + + Introduction Are you a skilled Registered Nurse ( RN )? Join our team ... and Addiction Services ( DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) as a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) !… more
- The Cigna Group (Bloomfield, CT)
- …and reimbursement for multiple Therapeutic Resource Centers. **QUALIFICATIONS** + Active, unencumbered Registered Nurse ( RN ) license in state of residency. ... Nurse Clinician - Accredo Job Description Summary The Nurse Clinician - RN is responsible for...is preferred in prior authorization or utilization review and appeals + Case Management experience… more
- Masonicare (Cromwell, CT)
- …as related to Hospice services. Certificates, Licenses, Registrations: Current Connecticut Registered Nurse License. Maintains current Drivers' License and auto ... RN Hospice Clinical Manager (Weekend Schedule) Job Location:...on-call schedules, plans and organizes daily assignments including the review and assignment of new patient referrals. + Supervises… more
- Guardian Life (Hartford, CT)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- The Cigna Group (Bloomfield, CT)
- …clients, brokers and other key stakeholders. + As Clinical Advisor, supports client utilization review and strategy meetings, providing medical cost trend, large ... health outcomes, client growth and retention, and network performance. **OVERVIEW:** The Nurse Executive Clinical Program Sr. Advisor, as part of the Clinical Sales… more
- Hartford HealthCare (Wethersfield, CT)
- …in the current, rapidly changing medical environment. *_Position Summary:_* The Clinical Resource Management Nurse is an integral part of the Care Management ... on their clinical needs incorporating the judgment of their provider. The Clinical Resource Management Nurse is able to work autonomously and swiftly, managing a… more
- Evolent (Hartford, CT)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more