- CVS Health (Cheyenne, WY)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CenterWell (Cheyenne, WY)
- …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 (Cheyenne, WY)
- **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 (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
- Evolent (Cheyenne, WY)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- CVS Health (Cheyenne, WY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… 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)
- …to ensure compliance and patient safety. * Participate in quality improvement, care management , risk management , peer review, utilization review, clinical ... 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 ... patients undergoing treatments. This role is best suited for an experienced nurse or an eager nurse wanting to grow into the role for this specialty. **BLS… more
- Centene Corporation (Cheyenne, WY)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Evolent (Cheyenne, WY)
- …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
- Banner Health (Torrington, WY)
- …the operations of the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change by developing, implementing and ... 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 effective… 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
- Sharecare (Cheyenne, WY)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… 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 ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… 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 ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- GE Aerospace (Cheyenne, WY)
- …does not directly own infrastructure platforms. The role accelerates digital utilization by standardizing data models, establishing reusable patterns, ensuring high ... data models, semantic layers, and reusable transformation patterns. **Data Management and Governance** + Implement data governance with domain-aligned stewardship,… more
- STG International (Yellowstone National Park, WY)
- …to ensure compliance and patient safety. * Participate in quality improvement, care management , risk management , peer review, utilization review, clinical ... after hire. Participate in the orientation of physician assistants and nurse practitioners. * Provide leadership to Yellowstone's Mammoth Clinic providers and… more
- Banner Health (Casper, WY)
- …the operations of the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change by developing, implementing and ... 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 effective… more
- Oracle (Cheyenne, WY)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more