- Humana (Concord, NH)
- …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
- CVS Health (Concord, NH)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Concord, NH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Concord, NH)
- …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
- CVS Health (Concord, NH)
- …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
- HCA Healthcare (Portsmouth, NH)
- … outcomes. **What you will do in this role:** + Inpatient wound care nurse to provide clinical oversight and coordinator for inpatient wound care services ... in their positions. Join our Team as a(an) Registred Nurse Inpatient Wound Care and access programs to assist...assist in providing support in decisions regarding cost effective utilization of wound care dressings, and supplies and pressure… more
- HCA Healthcare (Manchester, NH)
- …knowledge and expertise! **Job Summary and Qualifications** The House Supervisor/Bed Management Coordinator provides clinical supervision, leadership and support ... career opportunities as a(an) PRN House Supervisor RN Registered Nurse you want with your current employer? We have...meetings with hospital staff to identify and communicate bed utilization issues . With inpatient coordinators and clinical… more
- Dartmouth Health (Lebanon, NH)
- …Float position based in Lebanon NH Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces ... standards and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources. Responsibilities * Facilitates the development of… more
- Dartmouth Health (Lebanon, NH)
- …This is a Per Diem Float position Triages, coordinates and facilitates the clinical management for an assigned population. Develops, monitors and reinforces care ... standards and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources Responsibilities 1. Facilitates the development of… more
- WellSense (NH)
- …that works for our members, no matter their circumstances. **Job Summary** The Clinical Care Manager provides holistic medical care management services for ... members those who are homeless, undergoing organ transplantation, have multiple clinical and behavioral co-morbid conditions, and with special health care needs.… more
- Beth Israel Lahey Health (Exeter, NH)
- …as evidenced by staff and patient survey results. 10. Works together with the Clinical Nurse educators to ensure clinical competencies for staff. Equal ... Clinical Practice Supervisor-Core Family & Internal Medicine +...within 6 months of hire . Completion of required management training courses within 1 year of hire **Responsibilities:**… more
- HCA Healthcare (Derry, NH)
- …or compact state Registered Nurse license + Two or more years of clinical experience. + Case Management , Utilization & Managed Care experience and ... care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care,...medical necessity, admission status, level of care, and resource management . + The RN Case Manager Team Lead will… more
- Sharecare (Concord, NH)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Concord, NH)
- …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
- Genesis Healthcare (Wolfeboro, NH)
- …Regional Management and AlignMed Partners to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs. The ... in Wolfeboro, NH. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC… more
- HCA Healthcare (Portsmouth, NH)
- …2+ years experience in case management OR 3+ years experience in clinical nursing Required InterQual experience Preferred Registered Nurse license for New ... throughput while supporting a balance of optimal care and appropriate resource utilization . Provides case management services for both inpatient and observation… more
- HCA Healthcare (Portsmouth, NH)
- …2+ years experience in case management OR 3+ years experience in clinical nursing Required InterQual experience Preferred Registered Nurse license for New ... throughput while supporting a balance of optimal care and appropriate resource utilization . Provides case management services for both inpatient and observation… more
- Highmark Health (Concord, NH)
- …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
- Genesis Healthcare (North Conway, NH)
- …with assigned Centers and AlignMed Partners managers to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs ... North Conway, NH. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC… more
- Dartmouth Health (Hampstead, NH)
- …through the organization to promote functioning of hospital operations, including bed utilization . * Coordinates allocation of material resources. * Serves as an ... arbitrator for conflicts that arise on assigned shift. Facilitates short-term management of conflict and communicates to the appropriate departmental leadership for… more