- CVS Health (Jackson, MS)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CenterWell (Jackson, MS)
- …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 (Jackson, MS)
- **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
- Evolent (Jackson, MS)
- …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
- CVS Health (Jackson, MS)
- …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
- 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 Location: Remote - Candidates...systems + Medicaid, Medicare or insurance-related knowledge + Prior utilization management experience What We Offer +… more
- Evolent (Jackson, MS)
- …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
- Humana (Jackson, MS)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Fresenius Medical Center (Oxford, MS)
- …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
- Fresenius Medical Center (Gulfport, MS)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… 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 ... experience required + 3-5 years of experience in care management or utilization review required + 1-3...quality improvement. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Sharecare (Jackson, MS)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… 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 ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- STG International (Tupelo, MS)
- …to ensure compliance and patient safety. + Participates in quality improvement, care management , risk management , peer review, utilization review, clinical ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership to CBOC clinicians. + Evaluate the… 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 ... subject to change at the company's discretion. **Education** Required - Registered nurse diploma or bachelor's degree in related field Preferred - Master's degree… 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 ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- STG International (Holly Springs, MS)
- …to ensure compliance and patient safety. + Participate in quality improvement, care management , risk management , peer review, utilization review, clinical ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership to CBOC clinicians. + Evaluate the… more
- STG International (Tupelo, MS)
- …compliance and patient safety. + Design and participate in quality improvement, care management , risk management , peer review, utilization review, clinical ... the recruitment, and orientation of clinical staff physicians, physician assistants and nurse practitioners. + Collaborate with the CBOC Clinic Manager to provide… more
- GE Aerospace (Jackson, MS)
- …does not directly own infrastructure platforms. The role accelerates digital utilization by standardizing data models, establishing reusable patterns, ensuring high ... data models, semantic layers, and reusable transformation patterns. **Data Management and Governance** + Implement data governance with domain-aligned stewardship,… 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