- CenterWell (Providence, RI)
- …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 (Providence, RI)
- **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
- Evolent (Providence, RI)
- …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
- Hartford HealthCare (Norwich, CT)
- …balance. Every moment matters. And this is*your moment.* **Job:** ** Management * **Organization:** **Backus Hospital* **Title:** *Assistant Nurse Manager ... more about you! *JOB SUMMARY* The Assistant Nursing manager is a Registered Nurse (RN) who has responsibility for the supervision of patient care, clinical… more
- UCFS Healthcare (Norwich, CT)
- Per Diem Primary Care Nurse -RN/LPN Norwich, CT (http://maps.google.com/maps?q=47+Town+Street+Norwich+CT+USA+06360) Job Type Part-time Description UCFS is looking for ... the lives of others!We are currently seeking apart-time (per diem 16hrs) Nurse , RN/LPNwho will utilize critical thinking skills to interpret complex information in… more
- UCFS Healthcare (Norwich, CT)
- Pediatric Walk-In Center Nurse -RN/LPN Norwich, CT (http://maps.google.com/maps?q=47+Town+Street+Norwich+CT+USA+06360) Job Type Part-time Description UCFS is looking ... the lives of others!We are currently seeking apart-time (per diem 10hrs) Nurse , RN/LPNwho will utilize critical thinking skills to interpret complex information in… more
- Hartford HealthCare (Norwich, CT)
- …balance. Every moment matters. And this is*your moment*. **Job:** ** Management * **Organization:** **Backus Hospital* **Title:** *Assistant Nurse Manager ... of our communities. *JOB SUMMARY* The Assistant Nursing manager is a Registered Nurse (RN) who has responsibility for the supervision of patient care, clinical… more
- Fresenius Medical Center (Providence, RI)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Hartford HealthCare (Mansfield Center, CT)
- …including implementation, follow-through, and competency validation- in collaboration with Care Management and Quality teams. Oversees hospice care aide staffing to ... ensure appropriate resource utilization and meet client needs; manages hiring, scheduling, training,...supervisory home visits and development planning. Collaborates with Care Management and Quality teams to develop annual in-service programs;… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Hartford HealthCare (Mansfield Center, CT)
- …individual in this role provides clinical staff with guidance on documentation, utilization , and patient care decisions to support optimal clinical and operational ... outcomes. They review visit utilization for care appropriateness and collaborate with clinicians on...accredited educational program leading to licensure as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), or… more
- Sharecare (Providence, RI)
- …/ 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
- Highmark Health (Providence, RI)
- …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
- Edwards Lifesciences (Providence, RI)
- …an impact:** + Working independently in the areas of valve crimping, case management , pre-case planning, post-case management , 3 Mensio management , Therapy ... implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential customers… more
- Oracle (Providence, RI)
- …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