- Humana (Lincoln, NE)
- …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
- Cognizant (Lincoln, NE)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Molina Healthcare (Lincoln, NE)
- …hearing officer during fair hearings as may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Evolent (Lincoln, NE)
- …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
- Fresenius Medical Center (Grand Island, NE)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (Lincoln, NE)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Evolent (Lincoln, NE)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- CenterWell (Lincoln, NE)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... you to sit on-site at our Brooklyn Park, MN branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by … more
- CenterWell (Omaha, NE)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... you to sit on-site at our** **Omaha, NE** **branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by … more
- Molina Healthcare (Omaha, NE)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Omaha, NE)
- …key health care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. ... professionals, in some or all of the following functions: utilization management , care management , care...(RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW),… more
- Molina Healthcare (Lincoln, NE)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- Novo Nordisk (Omaha, NE)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... Northern Plains - NE, IA, ND, SD) Builds relationships and demonstrates the clinical outcome and benefits of NNI products. Educates and demonstrates the benefits of… more
- Molina Healthcare (Bellevue, NE)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying… more
- Banner Health (Ogallala, NE)
- … management process. Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process ... Name:** Ogallala PCP RHC **Work Shift:** Day **Job Category:** Clinical Care Banner Health was named to Fortune's America's...care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the… more
- Oracle (Lincoln, NE)
- …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
- Pine Acres Rehabilitation & Care Center (Nebraska City, NE)
- …to Administrator Reporting to this position: None Job Classification: Registered nurse with administrative duties/ management Position Purpose: Conducts and ... Must possess a current, unencumbered, active license to practice as a registered nurse in Nebraska. Must have 3 years' experience as a registered nurse… more
- Gentiva (Omaha, NE)
- …Nurse (RN) with strong leadership experience in hospice care, home health, or clinical operations management . If you're a natural leader who is passionate ... about patient-centered care, team development, and clinical excellence, we invite you to bring your talent...while driving branch revenue growth through census development, referral management , and efficient resource utilization + Maintain… more
- Highmark Health (Lincoln, NE)
- …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
- Omaha Children's Hospital (Omaha, NE)
- …screenings. * Communicates completion of tasks, and significant abnormalities or clinical changes. * Documentation is accurate, per clinic standard, and completed ... administration specific to area of assignment. * Facilitates registration and utilization of organization's health portal with patients and families. * Performs… more