- Molina Healthcare (Bowling Green, KY)
- …are seeking a Registered Nurse or Licensed Social Worker with PSYCH / BH Utilization Review / Utilization Management and knowledge of Interqual / MCG ... or COMPACT licensure is required for this role. We can consider a RN ( Registered Nurse), LCSW, LMFT, or LPCC._** **_WORK SCHEDULE: SUNDAY thru THURSDAY, OR TUESDAY… more
- Centene Corporation (Cheyenne, WY)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure… more
- Sharecare, Inc. (Greeneville, TN)
- …Job Functions:** + Partners directly with the Program Director, physicians, Resource/ Utilization /Case Management , diabetes staff and other hospital staff to ... . **Job Summary:** In partnership with Health System, the Hospital Diabetes Clinician is responsible for educating patients with diabetes in both inpatient and… more
- Molina Healthcare (Temecula, CA)
- …position we are seeking a Nurse with previous experience in Prior Auth Utilization Management and knowledge of Interqual or MCG guidelines. CALIFORNIA LICENSURE ... **_JOB TITLE: CARE REVIEW CLINICIAN , PRIOR AUTHORIZATION ( REGISTERED NURSE, OR...years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association**… more
- Planned Parenthood of Central and Western NY (Brighton, NY)
- Clinician (NP or PA) Brighton, NY (http://maps.google.com/maps?q=2253+S+Clinton+Ave+Brighton+NY+USA+14618) * Health Services Job Type Full-time Description ... Clinician (NP or PA) Brighton, NY Being a ...formulates treatment plans for patients based on findings and utilization of health histories; may refer more complex cases… more
- Molina Healthcare (Spokane, WA)
- …a candidate with a WA state LPN licensure. Candidates with p** **revious Utilization Management and Prior Authorization experience are highly preferred** **.** ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- Molina Healthcare (Richmond, KY)
- …Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Molina Healthcare (Houston, TX)
- …Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of ... internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Molina Healthcare (Milwaukee, WI)
- …Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of ... care/medical experience. **Required License, Certification, Association** Active, unrestricted Wisconsin Registered Nursing (RN) license in good standing. Must have… more
- Centene Corporation (New York, NY)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CVS Health (Baton Rouge, LA)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is ... external constituents in the coordination and administration of the utilization /benefit management function. **Required** **Qualifications** + Licensed… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... CareFirst's accreditation standards. We are looking for an experienced people leader and clinician in the greater Baltimore metropolitan area who is willing and able… more
- US Tech Solutions (Chicago, IL)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... you have experience with Utilization Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF UTILIZATION ... and Medicare). . Independently coordinates the clinical resolution with internal/external clinician support as required. . Processes and evaluates complex data and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the RN III Charge role is a licensed professional Registered Nurse (RN), who, as an advanced clinician , functions at the Proficient stage ... Benner's model of clinical practice. This position creates an environment for the management and delivery of safe patient care. In addition to fulfilling the duties… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Charge Nurse position is a licensed professional Registered Nurse (RN), who, as an experienced clinician , functions at the Competent to ... Benner's model of clinical practice. This position creates an environment for the management and delivery of safe patient care. In addition to fulfilling the duties… more
- University of Virginia (Charlottesville, VA)
- A dynamic professional clinician focused on population management with demonstrated capability to provide relationship-based care within a collaborative ... multidisciplinary team. This registered nurse utilizes advanced critical thinking to develop, implement,...the continuum of care. In addition, this position requires clinician provide afterhours/weekend coverage to serve as primary point… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Registered Nurse (RN) II position is a licensed staff nurse, an experienced clinician , functions at the Competent to Proficient stage ... to service line or hospital-wide initiatives in partnership with management . **PEOPLE ESSENTIAL FUNCTIONS** + Uses therapeutic communication, which includes… more