- Evolent (Cheyenne, WY)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Cardinal Health (Cheyenne, WY)
- …both scheduled outbound calls and inbound call queue. + Meets regularly with Clinical Supervisor and/or Senior Nurse , Individualized Care to discuss feedback ... who need them-faster.** **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties… more
- Oracle (Cheyenne, WY)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Humana (Cheyenne, WY)
- …a part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record ... complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently... clinical and coding experience to conduct a clinical validation review of the inpatient medical… more
- Highmark Health (Cheyenne, WY)
- …:** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs clinical review and data abstraction of patient records to support ... compliance with nationally recognized quality initiatives and the network's clinical process improvement and patient safety initiatives. The incumbent requires… more
- Datavant (Cheyenne, WY)
- …realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role ... Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. + Demonstrate understanding of… more
- CenterWell (Cheyenne, WY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience… more
- Humana (Cheyenne, WY)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Fujifilm (Cheyenne, WY)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...in: + MPI + MUGA + PET + (CV)Registered Nurse Cardiac experience in: + Cath, Peripheral Angiography, Electrophysiology… more
- Datavant (Cheyenne, WY)
- …Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued stay ... recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed… more
- Oracle (Cheyenne, WY)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- CenterWell (Cheyenne, WY)
- …in care, ensuring timeless access to important medications and solving urgent clinical needs. This Virtual Physician Collaborator shares in our vision to innovate ... in care, ensuring timeless access to important medications and solving urgent clinical needs. This Virtual Physician Collaborator shares in our vision to innovate… more
- Highmark Health (Cheyenne, WY)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Highmark Health (Cheyenne, WY)
- …**JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria ... interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established industry and… more
- CVS Health (Cheyenne, WY)
- …referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ... with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target… more
- Merck (Cheyenne, WY)
- …(Oncology group purchasing organizations, wholesalers, and specialty pharmacies). + Review and evaluate patterns for products purchased and prescribed (outpatient ... the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.… more