- Fresenius Medical Center (Montgomery, WV)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Highmark Health (Charleston, WV)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Charleston, WV)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- Healthfirst (WV)
- …practice with experience in appeals & grievances, claims processing, utilization review or utilization management /case management . + Demonstrated ... for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case summary, contract information,… more
- Humana (Charleston, WV)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Charleston, WV)
- …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
- CenterWell (South Charleston, WV)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- CommuniCare Health Services Corporate (Berkeley Springs, WV)
- RN Mobile MDS Coordinator, Registered Nurse CommuniCare Health Services is currently looking to fill the key position of Mobile MDS Coordinator, RN for ... successful candidate for the position must have a valid RN license in West Virginia, as well as previous...visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization ,… more
- BrightSpring Health Services (Dunbar, WV)
- …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse ( RN ) in good standing and currently licensed by ... and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate hours on… more
- Evolent (Charleston, WV)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases...patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care… more
- Guardian Life (Charleston, WV)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Sedgwick (Charleston, WV)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- Fresenius Medical Center (Morgantown, WV)
- …may be required. **SUPERVISION:** None **EDUCATION AND REQUIRED CREDENTIALS** **:** + Registered Nurse required + Certification in Nephrology Nursing or quality ... barriers to quality improvement. This includes promoting the adoption and utilization of Medical Advisory Board Recommended Algorithms and Standing Orders, clinical… more