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... influence department’s strategy. Makes decisions on moderately complex to complex issues ... license or similar medical certification (RN, MA, etc.) 5 years of ... if it is not already..
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... Bachelor's degree Licensed Registered Nurse (RN) in the Puerto Rico with ... in English/Spanish. See Additional Information on testing Comprehensive knowledge of Microsoft ... contributing to an organization focused..
... case management services are centered on the person rather than the ... achieving health and independence. Each RN Care Manager is assigned to ... do not have an Active..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
... inpatient care Licensed Registered Nurse (RN) in the (appropriate state) with ... obtain other state licensures based on business needs 3-5 years of ... Previous Medicare/Medicaid Experience a plus..
... - Saturday 8 AM - 7 PM Eastern . In addition ... Life Insurance 401(k) PTO including 7 paid holidays, one personal holiday, ... Bachelor's degree Licensed Registered Nurse..
... health services Determine the needs on the faxes, making appropriate and ... identifying, coordinating, and following through on quality concerns, sentinel events, complaints, ... Required Qualifications Degree in Nursing..
Description The Care Manager, Telephonic Nurse, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction ..
Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..
Description The Pre-Authorization Nurse 2 reviews Genetic testing prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description The Care Manager, Telephonic Behavioral Health 2, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
... functions and services to support 24/7 clinical operations delivery, Preauthorization List ... Medicaid; Implementing and hiring a 24/7 clinical support team for ability ... access to Care Management support..
... responsibilities for performing clinical audits on medical record documentation for quality ... medical reviews will be conducted on applied behavior analysis providers' claims ... providers are in compliance based..
