- Yakima Valley Farm Workers Clinic (Woodburn, OR)
- …and staff, ensure compliance with industry regulations, and uphold high practice management standards. The Director's impact will extend beyond the clinic as you ... mentors and trains direct report staff. Provides continuous performance management and conducts employee performance evaluations. Addresses performance and/or… more
- CVS Health (Salem, OR)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Salem, OR)
- …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
- CenterWell (Salem, OR)
- …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 (Salem, OR)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Centene Corporation (Salem, OR)
- …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** + LPN -… more
- Evolent (Salem, OR)
- …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 (St. Helens, OR)
- **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
- Catholic Health Initiatives (Pendleton, OR)
- …and Responsibilities** **Relocation Assistance Available!** **Job Summary** The Registered Nurse provides leadership and co-ordination to the health care team ... physicians, visitors and appropriate customer groups. Serves as safe clinical practitioner using independent but collaborative judgment **Essential Functions:** +… more
- CenterWell (Lake Oswego, OR)
- …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, ... a part of our caring community and help us put health first** The ** Clinical Manager** coordinates and oversees all direct care patient services provided by … more
- Providence (OR)
- …in a medical record. + 2 years - HEDIS, Quality management /quality improvement/ utilization review auditing experience, including experience in auditing ... Coding Quality Auditor, HEDIS who will:** + Be responsible for conducting clinical quality audits/overreads for the Quality Department + Identify and reports issues… more
- Datavant (Salem, OR)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Sharecare (Salem, OR)
- …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 (Salem, OR)
- …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
- Highmark Health (Salem, OR)
- …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
