- CenterWell (Madison, WI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …management , business architecture management , partnership management , requirements management , and change management . The Nurse Deputy Health ... in the following core informatics functions to include content management , application support, health information technology system optimization, enterprise data… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care. The Registered Nurse - ... EDRP application. Former EDRP participants ineligible to apply. Responsibilities This Registered Nurse - Community Living Center (CLC) position is located at the… more
- Veterans Affairs, Veterans Health Administration (Tomah, WI)
- …will be considered and referred as vacancies become available. The CLC Registered Nurse will focus on individual growth and development in practice with increased ... guidance in how to improve care provided to residents and families. The nurse brings principles and theory with limited application of critical thinking skills.… more
- Molina Healthcare (Madison, WI)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Veterans Affairs, Veterans Health Administration (Appleton, WI)
- …participants ineligible to apply. Responsibilities There is a full time opening for a Nurse Practitioner (NP) in the Primary Care Clinic at the Northeast John H. ... is highly preferred. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for… more
- Molina Healthcare (Madison, WI)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Evolent (Madison, WI)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Intermountain Health (Madison, WI)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Humana (Madison, WI)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Fresenius Medical Center (Madison, WI)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Elevance Health (Darlington, WI)
- …communities. The **LTSS Service Coordinator-RN Clinician** is responsible for overall management of member's case within the scope of licensure, develops, monitors, ... face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… more
- Fresenius Medical Center (Fitchburg, WI)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Sheboygan, WI)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Select Medical (Madison, WI)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... $10,000 Sign On Bonus **_Clinical license as a registered nurse or respiratory therapist or master's in social work...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more
- Molina Healthcare (Racine, WI)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Insight Global (Brookfield, WI)
- …cost containment strategies (bill review, utilization review, provider networks, nurse case management ). * Professional designations such as AIC, CPCU, ... the product across claims operations. * Provide expert guidance on medical management , litigation management , and complex claim handling strategies. * Translate… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …health care administration, or nursing. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + A minimum of five years of ... in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), Certified Professional Utilization Review… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Every. Single. Day. Aspirus Health in Wausau, WI is seeking a SUPERVISOR- WORKFORCE MANAGEMENT to join our PATIENT SERVICE CENTER team! Under the direction of the ... Support, Patient Service Center (PSC), the Supervisor - Workforce Management (WFM) provides operational leadership for enterprise forecasting, scheduling, real-time… more