- CVS Health (Salem, OR)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CenterWell (Salem, OR)
- …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 (Salem, OR)
- **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
- 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
- Veterans Affairs, Veterans Health Administration (Roseburg, OR)
- …position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex resident care. The Nurse (CLC) provides ... Set (MDS) coordinator to ensure accuracy of the Resource Utilization Group (RUG) score. Works with the facility wound...changes and reviews need for supplies. Assists facility wound nurse with teaching and support of residents with new… 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 ... based on ability/competence and scope of practice. + Is aware and demonstrates utilization of proper infection control standards and practices. + Is aware and… more
- Evolent (Salem, OR)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Lincoln County (Newport, OR)
- Community Health Nurse Print (https://www.governmentjobs.com/careers/lincoln/jobs/newprint/5041377) Apply Community Health Nurse Salary $40.19 - $54.02 Hourly ... Lincoln City Kite Festival Coastal Healthcare is looking for a Community Health Nurse to assist in providing direct patient care and treatment in our primary… more
- Fresenius Medical Center (Bend, OR)
- …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 (St. Helens, OR)
- …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
- 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, ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Providence (Beaverton, OR)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... who are terminal and nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing day to… more
- Sharecare (Salem, OR)
- …/ 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
- Providence (OR)
- …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
- 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 ... 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
- Highmark Health (Salem, OR)
- …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
- GE Aerospace (Salem, OR)
- …does not directly own infrastructure platforms. The role accelerates digital utilization by standardizing data models, establishing reusable patterns, ensuring high ... data models, semantic layers, and reusable transformation patterns. **Data Management and Governance** + Implement data governance with domain-aligned stewardship,… more
- Oracle (Salem, OR)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- GE Vernova (Remote, OR)
- …scenarios to evaluate alternatives and optimize delivery timelines and resource utilization . + Identify schedule risks and opportunities, driving mitigation and ... projects. + Background in cost control and earned value management (EVMS). + Experience in the hydropower industry. +...access to Health Coach from GE Vernova, a 24/7 nurse -based resource; and access to the Employee Assistance Program,… more