- CenterWell (Richmond, VA)
- …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 (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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Richmond, VA)
- …position **Preferred Qualifications** + Certified Case Manager + 3+ years Care Management , Discharge Planning and/or Home Health Care Coordination experience ... Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources… more
- ChenMed (Richmond, VA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment… more
- HCA Healthcare (Richmond, VA)
- …of RN experience in a hospital setting preferred. + Previous case management or utilization review experience preferred. Johnston-Willis Hospital has provided ... Hospital have the opportunity to make a real impact. As a **Registered Nurse RN Case Manager** you can be a part of change. **Benefits** Johnston-Willis… more
- Humana (Richmond, VA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals...Friday; 8:00 am-5 pm Eastern Standard Time **Work at Home Requirements** To ensure Hybrid Office/ Home associates'… more
- Evolent (Richmond, VA)
- …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
- 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
- Bon Secours Mercy Health (Petersburg, VA)
- …caring and connection for patients and families in the community we call home . Bon Secours - Southside Medical Center serves the communities of Petersburg, Hopewell, ... night shift/12hr shifts** **Summary of Primary Functions** The Critical Care Registered Nurse (RN) provides, coordinates, plans, and evaluates the care of the… more
- ChenMed (Colonial Heights, VA)
- …informed decisions re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and reimbursement for ... occasionally in acute care, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment. The responsibilities include… more
- Bon Secours Mercy Health (Petersburg, VA)
- …caring and connection for patients and families in the community we call home . Bon Secours - Southside Medical Center serves the communities of Petersburg, Hopewell, ... partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based… more
- Highmark Health (Richmond, VA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- HCA Healthcare (Richmond, VA)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... + Referral services for child, elder and pet care, home and auto repair, event planning and more +...clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Chippenham… more
- Sharecare (Richmond, VA)
- …/ 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
- HCA Healthcare (Richmond, VA)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity… more