- Humana (Santa Fe, NM)
- **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 (Santa Fe, NM)
- …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
- Molina Healthcare (Las Cruces, NM)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… more
- Fresenius Medical Center (Albuquerque, NM)
- …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
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... VA Health Care System Community Care Service seeks a Registered Nurse for the position of Women's...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- Highmark Health (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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
- LifePoint Health (Las Cruces, NM)
- …resources in the development of care, discharge planning and Utilization Review . * Utilization Management performs prospective, admissions, observation ... review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed...is desirable. * Current New Mexico licensure as a Registered Nurse . * Certification as CCM or… more
- Highmark Health (Santa Fe, NM)
- …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
- Molina Healthcare (Roswell, NM)
- …and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Children's Home Healthcare (Las Cruces, NM)
- …authorizations for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional ... * RN LICENSE REQUIRED, DO NOT APPLY IF YOU...CPR + At least 2 years experience as a Registered Nurse + At least 1 year...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Molina Healthcare (Roswell, NM)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Guardian Life (Santa Fe, NM)
- …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
- Molina Healthcare (Albuquerque, NM)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work… more
- Community Health Systems (Carlsbad, NM)
- …patient care coordination. + **Program Development:** Develop and implement care management programs, including utilization review , discharge planning, ... field) **Experience:** + **Required:** + 10 years of clinical RN experience, including 3 years in case management... RN experience, including 3 years in case management . + **Preferred:** + 2 years of leadership experience… more
- CenterWell (Albuquerque, NM)
- …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
- Magellan Health Services (Albuquerque, NM)
- …- Licensed Professional Counselor - Care Mgmt, PC - Professional Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... the management , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care … more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …two years of experience in clinical documentation improvement; OR, Clinical experience, such as Registered Nurse ( RN ), Medical Doctor (MD), or Doctor of ... Summary This position is located in the Health Information Management (HIM) section at the New Mexico VA Medical Center. MRTs (Coder) are skilled in classifying… more