- Humana (Richmond, VA)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ... community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- University of Virginia (Charlottesville, VA)
- Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management ... UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission… more
- Humana (Richmond, VA)
- …in an adult learning environment **OR** one (1) or more years successfully working as a Utilization Management Nurse or BH Utilization Management ... first** Humana Healthy Horizons in Virginia is seeking a Learning Facilitator/Preceptor, Utilization Management (Learning Facilitation Professional 2 ) who… more
- Elevance Health (Norfolk, VA)
- …**Preferred skills, Capabilities, and Experience:** + Compact license is preferred. + Utilization Management experience preferred. + Medicaid Utilization ... a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review...Management Non-Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts… more
- Humana (Richmond, VA)
- …**Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project Management Professional (PMP) certification ... are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality… more
- Veterans Affairs, Veterans Health Administration (Hampton, VA)
- …in a health-related field. Previous Referral Coordination, Care coordination, research, case management or nurse navigation experience. 2 -4 years Specialty ... of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community...nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN… more
- Veterans Affairs, Veterans Health Administration (Salem, VA)
- …of nursing education, orientation, competencies, and providing quality improvement and outcomes utilization . Registered Nurse delivers and manages the care of ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care....nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN… more
- Bon Secours Mercy Health (Newport News, VA)
- …sign on bonus** **Summary of Primary Function** The Obstetrics (OB) Registered Nurse (RN) addresses the care provided to healthcare consumers in the context ... Functions** + In collaboration with the interdisciplinary care team (Care Management in coordinating care [e.g. Children's Protective Services], transfer centers,… more
- Elevance Health (Norfolk, VA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- Elevance Health (Norfolk, VA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- KBR (Virginia Beach, VA)
- …organization, ie Commission for Case Management Certification, American Case Management Association or American Nurse Credentialing Center, or shall obtain ... Title: Special Operations Nurse Case Manager (JEB Little Creek, VA) THIS...care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential… more
- HCA Healthcare (Richmond, VA)
- …of RN experience in a hospital setting preferred.** + **Previous case management or utilization review experience preferred.** CJW Medical Center ... make a real impact with your work? With over 2 ,000 sites of care and serving over 31. 2...opportunity to make a real impact. As a Registered Nurse RN Case Manager you can be a part… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …nursing assessment and testing. This position requires critical thinking, time management , excellent communication skills and also thorough knowledge of adult ... of Primary Function/General Purpose of Position** The Surgical Services Registered Nurse (RN) delivers patient care utilizing the nursing process through data… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …YEAR OF RN EXPERIENCE!** Summary of Primary Function The Obstetrics (OB) Registered Nurse (RN) addresses the care provided to healthcare consumers in the context of ... Functions * In collaboration with the interdisciplinary care team (Care Management in coordinating care [e.g. Children's Protective Services], transfer centers, and… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …YEAR OF RN EXPERIENCE!** **Summary of Primary Function** The Obstetrics (OB) Registered Nurse (RN) addresses the care provided to healthcare consumers in the context ... Functions** + In collaboration with the interdisciplinary care team (Care Management in coordinating care [e.g. Children's Protective Services], transfer centers,… more
- Humana (Richmond, VA)
- …ad hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable ... caring community and help us put health first** The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 … more
- ChenMed (Colonial Heights, VA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in this role ... JOB DUTIES/RESPONSIBILITIES:** + Coordinates the integration of social services/case management functions into the patient care, discharge and home planning… more
- Elevance Health (Norfolk, VA)
- …Level:** Non- Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation ... responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment… more
- Sunrise Senior Living (Arlington, VA)
- …regulations. + A minimum of two ( 2 ) years' experience in a nurse management position within a skilled nursing environment including hiring staff, coaching, ... The Director of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning, organizing and… more
- University of Virginia (Charlottesville, VA)
- …facilitate and safe and efficient patient transfer. + As an experienced Registered Nurse , the RN Transfer Coordinator is responsible for the intake and logistics of ... for accepting physicians Identifies health needs based on assessment and utilization of guidelines. Facilitates appropriate disposition based on assessment, triage… more