- Humana (Jefferson City, MO)
- **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 (Jefferson City, MO)
- …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 (Sullivan, MO)
- …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 (St. Louis, MO)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Highmark Health (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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
- Community Health Systems (Poplar Bluff, MO)
- …stages of the care continuum. This role involves developing and implementing case management programs, including utilization review , intake or discharge ... ensuring effective planning, delivery, and follow-up. + Develop and implement care management programs, including utilization review , discharge planning, and… more
- Highmark Health (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Humana (Jefferson City, MO)
- …Family Therapist **(LMFT)** , Licensed Professional Counselor **(LPC)** , Psychologist **(PhD)** , Registered Nurse **( RN )** or other professional license. + ... us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health… more
- CenterWell (St. Louis, MO)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Guardian Life (Jefferson City, MO)
- …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
- NHS Management, LLC (Joplin, MO)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. + Receives physicians' instructions regarding resident ... medical plan! We are in search of a qualified RN Unit Manager : + Assists in maintaining resident...documentation of treatment and nursing observations. Qualifications: + Current RN license by State required with experience in the… more
- HCA Healthcare (Kansas City, MO)
- …Master's degree in Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse ( RN ) licensure , Licensed Clinical Social ... interdisciplinary teams and external stakeholders. The Director is a registered nurse with responsibility for all operational...we encourage you to apply for our Director Case Management opening. We promptly review all applications.… more
- Elevance Health (MO)
- …experience. **Preferred skills, qualifications and experiences:** + Prior experience in inpatient Utilization Management , preferred. + 3-5 years of experience in ... **Be Part of an Extraordinary Team** ** Nurse Medical Management I** **Location:** Remote-...are not limited to: + Conducts pre-certification, continued stay review , care coordination, or discharge planning for appropriateness of… more
- HCA Healthcare (Kansas City, MO)
- …opportunity compelling, we encourage you to apply for our Social Worker Case Management opening. We promptly review all applications. Highly qualified candidates ... and family needs with the efficacious and cost effective utilization of resources + Serves as a transplant social...as a transplant social worker resource for hospital case management working with transplant patients + Knowledge of payer… more
- Elevance Health (St. Louis, MO)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Elevance Health (St. Louis, MO)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more