- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Highmark Health (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Humana (Hartford, CT)
- …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
- Baystate Health (Springfield, MA)
- …- American Heart AssociationAmerican Heart Association, Driver License - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... ** RN , Pediatric Nurse Care Manager -...management application is required and is vital. Care management program metrics including, emergency room utilization ,… more
- Baystate Health (Springfield, MA)
- **Hospital Case Manager** Per Diem The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and financial ... and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers… more
- Guardian Life (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Molina Healthcare (Farmington, CT)
- **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and...years of experience in case management , disease management or utilization management in… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …for Mental Health Intensive level of care beds in the community, provides utilization review of all contracted services including support services from ... based team/unit . + Experience reviewing budgets, use of excel, and utilization management strategies. SPECIAL REQUIREMENTS Incumbents in this class must… more
- Baystate Health (Springfield, MA)
- …care management application is required and is vital. Care management program metrics including, emergency room utilization , and hospital ... & Transitions of Care Team_** is responsible for the management of care for a defined group of patients...of care and revise it as necessary to meet goals. RN to provide a final review of… more
- Eastern Connecticut Health Network (Vernon, CT)
- …be a graduate of an accredited school of Nursing and have and maintain a current Registered Nurse license in the State of Connecticut. Must provide a copy of ... Why consider applying to Visiting Nurse & Health Services of CT? Here are...provided by clinicians through conferences, home visits and record review . Also has responsibility for the wound care program.… more
- Baystate Health (Springfield, MA)
- …The Schedule Coordinator will be responsible for scheduling contingency staff as needed: RN s, PCTs, OAs, OA/MTs and any additional staff that may be needed ... also field employee sick calls and search for replacements as needed; review schedules in advance for pre-scheduling known unfilled shifts (Vacation, FMLA, etc.)… more