- Humana (Springfield, IL)
- …Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), RN ( Registered Nurse ) or other behavioral health professional licenses. ... and help us put health first** Humana Healthy Horizons is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral … more
- Highmark Health (Springfield, IL)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Sharecare, Inc. (Springfield, IL)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... with the participants and their Primary Care Provider according to the disease management program intervention guidelines. An RN is supervised by an Operations… more
- CVS Health (Springfield, IL)
- …role is 100% remote and the candidate can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant...Required Qualifications: - Must have active current and unrestricted RN licensure in state of residence - 3+ years… more
- CVS Health (Springfield, IL)
- …of experience in a managed care clinical operation environment ( utilization management , case management , and/or behavioral health case management ... lives in new markets across the country. + The Nurse Educator will support the training and compliance monitoring...support the training and compliance monitoring of the DSNP/MMP Management team. They are responsible for conducting audits of… more
- Highmark Health (Springfield, IL)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more