- 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
- 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...Friday; 8:00 am-5 pm Eastern Standard Time **Work at Home Requirements** To ensure Hybrid Office/ Home associates'… 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
- Fresenius Medical Center (Oxford, MS)
- …and acting on adverse events and action thresholds. + Oversees facility's Home Therapies Program if applicable. + Accountable for compliance with all applicable ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Highmark Health (Jackson, MS)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… 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
- 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
- Community Health Systems (Hattiesburg, MS)
- …health, or nursing home setting required + 2-4 years of care management experience preferred **Knowledge, Skills and Abilities** + Strong understanding of case ... outdoor recreation, and family-friendly neighborhoods, Hattiesburg is a welcoming place to call home . It's also home to The University of Southern Mississippi… more
- Community Health Systems (Vicksburg, MS)
- …health, or nursing home setting required + 2-4 years of care management experience preferred **Knowledge, Skills and Abilities** + Strong understanding of case ... it's a city where you can truly feel at home . **Job Summary** The Care Manager - RN is...and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role… more
- Community Health Systems (Vicksburg, MS)
- …health, or nursing home setting required + 2-4 years of care management experience preferred **Knowledge, Skills and Abilities** + Strong understanding of case ... recreation, it's a place where you'll quickly feel at home . Learn more about the city at Visit Vicksburg...and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role… more