- Humana (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Elevance Health (Richmond, VA)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. +… more
- Evolent (Richmond, VA)
- …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
- Bon Secours Mercy Health (Mechanicsville, VA)
- …observation experiences throughout the program. The educators, along with preceptor and Nurse Directors, assess each participant's clinical progression to match ... and partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate,… more
- Elevance Health (Richmond, VA)
- **Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience;… more
- CVS Health (Richmond, VA)
- …leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Fully Integrated Dual ... has an understanding on how to take their ordered medications. + Providing clinical assistance to determine appropriate services and supports due to member's health… more
- ChenMed (Richmond, VA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to ... our team. The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- Summary Registered Nurse - Float Pool Demonstrates integration of biopsychosocial concepts, cognitive skills, and technically competent practice while providing care ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …the EDRP application. Former EDRP participants ineligible to apply. Responsibilities Registered Nurse - Inpatient Spinal Cord The Inpatient Staff Registered Nurse ... nursing practice and determines the appropriate delegation of tasks consistent with the nurse 's obligation to provide optimal care. The focus is on individual growth… more
- ChenMed (Colonial Heights, VA)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required. The PCP ... who plays a key role as part of the clinical operations team providing direct patient care and providing...re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and… more
- Bon Secours Mercy Health (Petersburg, VA)
- …* Protects the safety and privacy of all persons. * Understanding and utilization of office and clinical technologies. * Ability to communicate with ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. _Southside Regional Medical Center is your community… more
- ChenMed (Richmond, VA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more
- Elevance Health (Richmond, VA)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Elevance Health (Richmond, VA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Richmond, VA)
- …to 8:00 PM EST. The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... ** Nurse Case Manager II** **Location:** This role enables...providers, claims or service issues. Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Bon Secours Mercy Health (Richmond, VA)
- …cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Job Description **Registered Nurse (RN) - ... and partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate,… more
- Elevance Health (Richmond, VA)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... Commonwealth of Virginia is required. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Requires HS diploma or… more
- Highmark Health (Richmond, VA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... Nursing **EXPERIENCE** **Required** + 3 years of related, progressive clinical experience in the area of specialization + Experience...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more