- University of New Mexico - Hospitals (Albuquerque, NM)
- …limited to experience, education, and other business and organizational considerations. Department: Utilization Management - UH Read on to fully understand what ... appropriate patients within designated specialty area requiring patient case management interventions by utilizing established procedures including census review,… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …limited to experience, education, and other business and organizational considerations. Department: Utilization Management - UH FTE: 0.50 Part Time Shift: ... patient outcomes are achieved within established time frames and with efficient utilization of resources. Conduct initial and ongoing assessments, initiate disease … more
- University of New Mexico - Hospitals (Rio Rancho, NM)
- …and facilitate communication, problem solving, decision-making, crisis intervention, resource utilization , and conflict management * SUPERVISION - Develop ... Essential: * Sig Hazard: Chemicals, Bio Hazardous Materials req PPE * Subject to an annual contract and performance appraisal Department: Registered Nurse more
- CenterWell (Santa Fe, NM)
- …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
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Molina Healthcare (Roswell, NM)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Molina Healthcare (Las Cruces, NM)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- MTC (Chaparral, NM)
- …performing the duties of the position. + Implement basic cost containment and utilization management for patient care and facility operations. + Maintain ... attendance is required. **Education and Experience Requirements:** + **Advanced Registered Nurse Practitioner:** Graduate of a Master of Nursing program. Successful… more
- Evolent (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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
- Elevance Health (NM)
- …nursing preferred. + Participation and/or certification in a managed care or utilization management organization preferred. + Ability to understand clinical ... two-week period which includes Saturday and Sunday every other weekend. The **Triage Nurse I - CareBridge** is responsible for determining the appropriate Care … more
- Fresenius Medical Center (Albuquerque, NM)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... quality of patient care, as defined by the quality goals, by working with management to ensure that policies and procedures are followed. + Assists with implementing… more
- Fresenius Medical Center (Farmington, NM)
- …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 (Albuquerque, NM)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Community Health Systems (Carlsbad, NM)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... experience required + 3-5 years of experience in care management or utilization review required + 1-3...quality improvement. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Molina Healthcare (Rio Rancho, NM)
- …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 (NM)
- …3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active, ... Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or...unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- Molina Healthcare (Las Cruces, NM)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of… more
- Magellan Health Services (Albuquerque, NM)
- …the management , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care ... management staff, providing expertise in designated programs. + Assists clinical management in the development and on-going management of designated staff. +… more
- Providence (NM)
- …in a medical record. + 2 years - HEDIS, Quality management /quality improvement/ utilization review auditing experience, including experience in auditing ... Qualification:** + Technical certification/licensure in the area of Medical Assistant, Certified Nurse Assistant, or Licensed Practical Nurse upon hire. + HS… more
