- CenterWell (Carson City, NV)
- …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
- Elevance Health (Las Vegas, NV)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- HCA Healthcare (Las Vegas, NV)
- …our colleagues in their positions. Join our Team as a(an) Clinical Registered Nurse Coordinator- MedSurg and access programs to assist with every stage of your ... gain certifications and job skills. Apply today for our Clinical Registered Nurse Coordinator- MedSurg opening and continue to learn! **Job Summary and… more
- Evolent (Carson City, NV)
- …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
- Intermountain Health (Carson City, NV)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Centene Corporation (Carson City, NV)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN -… more
- Fresenius Medical Center (Reno, NV)
- …direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
- Molina Healthcare (Sparks, NV)
- …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 (Reno, NV)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...experience. * At least 1 year of health care management /leadership experience. * Registered Nurse (RN), Licensed… more
- HCA Healthcare (Las Vegas, NV)
- …you want to join an organization that invests in you as a Director Case Management ? At Sunrise Hospital, you come first. HCA Healthcare has committed up to $300 ... difference. We are looking for a dedicated Director Case Management like you to be a part of our...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of… more
- Highmark Health (Carson City, NV)
- …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
- Molina Healthcare (North Las Vegas, NV)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in...emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- Datavant (Carson City, NV)
- …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
- CVS Health (Carson City, NV)
- …- 3+ years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS Office suites - Must be ... year - Occasional travel less than 5% to complete audits/meetings - Utilization Management is a 24/7 operation and work schedules will include weekends,… more
- Sharecare (Carson City, NV)
- …/ 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
- Molina Healthcare (Sparks, NV)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... attitude for success **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). RN licensure preferred… more
- Elevance Health (Las Vegas, NV)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians....orientation materials. + May complete quality audits and assist management with developing associated corrective action plans. + May… more
- Highmark Health (Carson City, NV)
- …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
- HCA Healthcare (Las Vegas, NV)
- …opening and continue to learn! **Job Summary and Qualifications** **The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating ... stay, managing the length of stay, ensuring appropriate resource management , and developing a safe appropriate discharge plan in...supporting a balance of optimal care and appropriate resource utilization .** **What you will do in this role:** +… more
- HCA Healthcare (Las Vegas, NV)
- …Nurses at MountainView Hospital! **Job Summary and Qualifications** **The Registered Nurse (RN) CM is responsible for promoting patient-centered care by coordinating ... stay, managing the length of stay, ensuring appropriate resource management , and developing a safe appropriate discharge plan in...supporting a balance of optimal care and appropriate resource utilization .** **What you will do in this role:** +… more