- Cognizant (Providence, RI)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Hartford HealthCare (Willimantic, CT)
- …moment.* **Job:** **Nursing* **Organization:** **Windham Hospital* **Title:** * Registered Nurse Case Manager (RN) - Utilization Management* **Location:** ... required. Case management experience preferred. *LICENSURE/CERTIFICATION* * Current license as a registered nurse in the State of Connecticut. * Certification in… more
- Humana (Providence, RI)
- **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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Evolent (Providence, RI)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Edward M. Kennedy Community Health Center, Inc. (Worcester, MA)
- …may require evening, weekend and/or holiday shifts on a rotating basis. Job Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience ... to support this growth. We are currently hiring a Clinical Care Manager based in Worcester, MA. The ...patient engagement, reduce risk, and minimize hospital and ER utilization . + Identifies, manages, and coordinates patient care, providing… more
- Fallon Health (Worcester, MA)
- … Nurse in Massachusetts. **Experience:** * A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting ... nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences,...required. * 2 years' experience as a Utilization Management/Prior Authorization nurse in a managed… more
- Hartford HealthCare (Mansfield Center, CT)
- …settings. Degree from an accredited educational program leading to licensure as a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), or ... and policy adherence. The individual in this role provides clinical staff with guidance on documentation, utilization ,...provides clinical staff with guidance on documentation, utilization , and patient care decisions to support optimal … more
- Charter Care Health Partners (North Providence, RI)
- …Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse 's ... Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization ...residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical… more
- Charter Care Health Partners (North Providence, RI)
- …Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse 's ... Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization ...residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical… more
- University of Connecticut (UConn) (Storrs, CT)
- …as necessary. + Performs related duties as assigned. MINIMUM QUALIFICATIONS + Licensed as a Registered Nurse in the State of CT. + Bachelor's degree in Nursing ... Under the general supervision of the Director of Nursing and the Nurse Manager, these positions provide professional nursing care and health services, including… more
- Highmark Health (Providence, RI)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more