- CVS Health (Springfield, IL)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CVS Health (Springfield, IL)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CST zones **Education**… more
- CenterWell (Springfield, IL)
- …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
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- CVS Health (Springfield, IL)
- …with heart, each and every day. **Position Summary** As a Care Management Associate you will be supporting comprehensive coordination of medical services including ... and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare… more
- CVS Health (Springfield, IL)
- …active, unrestricted pharmacist licensure within their state of residence.** Medication Therapy Management supports the company vision to help people on their path ... The role of the MTM Pharmacist is to deliver telephonic medication therapy management (MTM). Effective delivery of this CVS Health telephonic based MTM service… more
- CVS Health (Springfield, IL)
- …CM, discharge planning and/or home health care coordination experience + Previous Utilization Management experience, transitions of care and discharge planning ... Services and strategies, policies and programs are comprised of network management , clinical coverage, and policies. **Position Summary/Mission** Community Care… more
- Sharecare (Springfield, IL)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Datavant (Springfield, IL)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Oracle (Springfield, IL)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Highmark Health (Springfield, IL)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Veterans Affairs, Veterans Health Administration (Springfield, IL)
- …These operations are carried out with assistance from staff members from other clinical and support services that are supervised by their clinical service ... adequate and comprehensive services and communicates these to staff physicians, nurse practitioners, physician assistants and other members of Ambulator Care.… more