- Humana (Cheyenne, WY)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CenterWell (Cheyenne, WY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Cheyenne, WY)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Cheyenne, WY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Veterans Affairs, Veterans Health Administration (Sheridan, WY)
- …responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation demonstrating leadership in delivering and improving holistic… more
- Veterans Affairs, Veterans Health Administration (Sheridan, WY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization This nurse integrates knowledge, skills, abilities, and ... for the coordination of care focused on patient education, self- management , & customer satisfaction throughout the continuum of care....and Responsibilities include but ARE NOT limited to: The Nurse Inpatient Staff Registered Nurse (RN) is… more
- STG International (Yellowstone National Park, WY)
- …patient safety. * Participate in quality improvement, care management , risk management , peer review, utilization review, clinical outcomes, and health ... STGI is currently seeking a Primary Care Provider (Physician Assistant or Nurse Practitioner) to join our team. JOB SUMMARY: The general duty of the Primary Care… more
- Banner Health (Worland, WY)
- … management process. Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process ... **Department Name:** C/P-Worland Oncology-Clinic **Work Shift:** Day **Job Category:** Clinical Care **$2,000 Sign on Bonus Available** Find your...treatments. This role is best suited for an experienced nurse or an eager nurse wanting to… more
- Banner Health (Torrington, WY)
- …and clinical support to patients and staff. Uses depth and breadth of clinical management knowledge to ensure the provision of high quality, safe, and cost ... the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change...management as normally demonstrated through two years of clinical management experience relevant to patient population.… more
- Banner Health (Casper, WY)
- …both patients and staff, working with the inventory team, and will also be the charge nurse each day when working in the cardiac cath lab. This role will also work ... direction of the director. CORE FUNCTIONS 1. Coordinates oversight of quality, risk management , safety and nursing standards and is a role model and resource person… more
- Banner Health (Casper, WY)
- …and clinical support to patients and staff. Uses depth and breadth of clinical management knowledge to ensure the provision of high quality, safe, and cost ... the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change...management as normally demonstrated through two years of clinical management experience relevant to patient population.… more
- CVS Health (Cheyenne, WY)
- …- 3+ years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS Office suites - Must be ... of high performing teams. Works closely with functional area management to ensure consistency in clinical interventions...Occasional travel less than 5% to complete audits/meetings - Utilization Management is a 24/7 operation and… more
- Highmark Health (Cheyenne, WY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... Nursing **EXPERIENCE** **Required** + 3 years of related, progressive clinical experience in the area of specialization + Experience...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- Datavant (Cheyenne, WY)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Sharecare (Cheyenne, WY)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Cheyenne, WY)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- STG International (Yellowstone National Park, WY)
- …patient safety. * Participate in quality improvement, care management , risk management , peer review, utilization review, clinical outcomes, and health ... after hire. Participate in the orientation of physician assistants and nurse practitioners. * Provide leadership to Yellowstone's Mammoth Clinic providers and… more
- Highmark Health (Cheyenne, WY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Veterans Affairs, Veterans Health Administration (Sheridan, WY)
- … nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting ... occurs. Incumbent utilizes various reports from the MSA Supervisor, ie Clinic Utilization Statistical Summary, to ensure clinic setup is closely monitored to… more