- Humana (Jackson, MS)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CenterWell (Jackson, MS)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Jackson, MS)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Jackson, MS)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Actalent (Jackson, MS)
- …Trucare Cloud preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel, and ... Clinical Review Nurse - Concurrent Review...systems + Medicaid, Medicare or insurance-related knowledge + Prior utilization management experience What We Offer +… more
- Fresenius Medical Center (Oxford, MS)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more
- Community Health Systems (Hattiesburg, MS)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... or a related field preferred + 4-6 years of clinical nursing experience required + 3-5 years of experience...experience required + 3-5 years of experience in care management or utilization review required + 1-3… more
- Highmark Health (Jackson, MS)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... Nursing **EXPERIENCE** **Required** + 3 years of related, progressive clinical experience in the area of specialization + Experience...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- STG International (Tupelo, MS)
- …patient safety. + Participates in quality improvement, care management , risk management , peer review, utilization review, clinical outcomes, and health ... into the VA health care system. + Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership… more
- STG International (Tupelo, MS)
- …safety. + Design and participate in quality improvement, care management , risk management , peer review, utilization review, clinical outcomes, and health ... patients. + Coordinate and participate in the recruitment, and orientation of clinical staff physicians, physician assistants and nurse practitioners. +… more
- Datavant (Jackson, MS)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Sharecare (Jackson, MS)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- STG International (Holly Springs, MS)
- …patient safety. + Participate in quality improvement, care management , risk management , peer review, utilization review, clinical outcomes, and health ... Veteran's Administration health care system. + Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. +… more
- Ochsner Health (Union, MS)
- …Health and discover your future today!** This job works with organizational management to implement and maintain a nationally recognized Diabetes Self- Management ... health, medications, psychosocial issues and identifies areas for education and clinical interventions based on current national diabetes care standards and… more
- Oracle (Jackson, MS)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Highmark Health (Jackson, MS)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Community Health Systems (Flowood, MS)
- …with hospital policies and regulatory standards, serving as a resource for clinical and non- clinical staff. **Essential Functions** + Oversees hospital ... hospital census, coordinates admissions, discharges, and transfers, and ensures optimal bed utilization . + Acts as the administrative point of contact for staff,… more
- Community Health Systems (Vicksburg, MS)
- …coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves ... to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams (IDT) to… more
- Community Health Systems (Vicksburg, MS)
- …coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves ... to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams (IDT) to… more