Job Title: Utilization Management Nurse Job Description Perform a minimum of 25 reviews a day with a 97% QA review.... Provide consultation and responses to utilization management requests. Establish relationships and engage with members...
at Wellmark . Job Description Use Your Strengths as a Case Management Nurse at Wellmark! About the role: As a Case... Management Nurse I, you will serve as a key advisor who actively engages with members through a variety of channels to foster...
- Prior experience in Utilization Management - Knowledge of health regulations, guidelines, and coverage issues Home... or equivalent combination of education or experience - Current Licensed Practical Nurse (LPN) OR Current Registered Nurse (RN...
. Demonstrates compliance with facility-wide Utilization Management policies and procedures. Coordinates UR compliance with Quality... discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW (potential license per state guidelines...
and internal guidelines; remains current and consistent with the standards pertinent to utilization management services. h... within a call center setting facilitating care management functions, including eligibility and benefit verification, authorization...
physicians, nurse practitioners, pharmacists, psychiatrists, registered nurses, licensed clinical social workers... population health metrics, including quality measures, utilization measures, and financial measures Other duties, as assigned...