- Humana (Richmond, VA)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review Post-Acute Preauth cases using ... caring community and help us put health first** The Utilization Management Nurse utilizes clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) compact license… more
- HCA Healthcare (Richmond, VA)
- …every year, nurses at Chippenham Hospital have the opportunity to make a real impact. As a Registered Nurse RN Case Manager you can be a part of change. ... benefits may vary by location._ We are seeking a Registered Nurse RN Case Manager...experience in a hospital setting preferred.** + **Previous case management or utilization review experience… more
- HCA Healthcare (Richmond, VA)
- …your career path, we encourage you to apply for our Case Manager Registered Nurse RN PRN opening. We review all applications. Qualified candidates will ... you have the career opportunities as a(an) Case Manager Registered Nurse RN PRN you...payers and maintains legible documentation as directed by the Utilization Management Plan + As a member… more
- Bon Secours Mercy Health (Richmond, VA)
- …stewardship to create an environment where associates want to work and help communities thrive. ** Registered Nurse ( RN ) - Physician Office - Bon Secours - ... Cardiology, Reynolds - Richmond, VA** **_Are you an RN with Oncology experience? If you have any interest...cardiology step down or critical care experience as a Registered Nurse + Experience within a physician… more
- Humana (Richmond, VA)
- …supports the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will review prior authorization requests for appropriate ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will...experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG… more
- Elevance Health (Richmond, VA)
- …PulsePoint office. This utilization management role is responsible for utilization management review for Behavior Analysis services. **How you will ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Highmark Health (Richmond, VA)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Molina Healthcare (Richmond, VA)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse or LCSW who lives in VIRGINIA and must be licensed for the state of VIRGINIA. ... integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical… more
- Humana (Richmond, VA)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) compact licensure… more
- HCA Healthcare (Richmond, VA)
- …of social work experience in an acute care setting preferred. + Previous case management or utilization review experience preferred. CJW Medical Center ... as appropriate. + You will perform admission and concurrent review for all payers and maintain legible documentation as...payers and maintain legible documentation as directed by the Utilization Management Plan. **What qualifications you will… more
- CVS Health (Richmond, VA)
- …to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% ... remote. As a Utilization Nurse Consultant, you will utilize clinical...suites experience including Outlook and Excel **Preferred Qualifications** + Utilization Review experience + Managed Care experience… more
- Guardian Life (Richmond, VA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Elevance Health (Richmond, VA)
- …Focuses on relatively complex case types that require the training and skill of a registered nurse . Acts as a resource for more junior Clinicians. **How you'll ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid… more
- Elevance Health (Richmond, VA)
- **Medical Management Nurse ** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, ... pm (EST) shift rotation twice a month.** The **Medical Management Nurse ** is responsible for reviewing the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- HCA Healthcare (Richmond, VA)
- …Leadership over staff, supervisors, educator/OR Liaison. Must have solid track record of management and building a successful team. 2. Hires and manages HR issues ... guidelines based on the AAMI Standards. 13. Works closely with surgical services management team on day to day operations and department needs. 14. Manages and… more
- HCA Healthcare (Richmond, VA)
- …we do. We want you to apply! **Job Summary and Qualifications** The Virginia registered pharmacist shall carry out duties assigned by the Director of Pharmacy and ... organizing, networking, completing and improving the work activities through effective management of time, tasks and available personnel. + Maintains knowledge… more
- HCA Healthcare (Richmond, VA)
- …we do. We want you to apply! **Job Summary and Qualifications** The Virginia registered pharmacist shall carry out duties assigned by the Director of Pharmacy and ... organizing, networking, completing and improving the work activities through effective management of time, tasks and available personnel. + Maintains knowledge… more