A health insurance company needs applicants for an opening for a Telecommute Compliance and Auditing Nurse. Individual must be able to fulfill the following responsibilities: Review utilization management activities. Ensure adherence to policies, procedures, and regulations.
An insurance company is searching for a person to fill their position for a Remote Registered Nurse Utilization Management Nurse Consultant. Core Responsibilities Include: Communicating with providers and other parties. Gathering clinical information.
A health insurance and wellness company has a current position open for a Telecommute Care Management Nurse 2. Individual must be able to fulfill the following responsibilities: Manage a member's health issues. Identify and resolve barriers that hinder effective care.
2+ years of acute hospital clinical experience. 4+ years of utilization management experience. Current RN license in NewJersey and any other compact states. Knowledge of current standard of medical practices and insurance benefits. Familiarity with Milliman and InterQual guidelines.
This position is a Field opportunity. Must possess an active, unencumbered license in state of residence and the State of NewJersey. Registered Nurse. Required to become CHCQM certified by the ABQAURP within one year of hire. Minimum 1-year prior case management experience.
Licensed Registered Nurse or Licensed Clinical Social Worker. 3+ years of health care industry experience. 3+ years of behavioral health managed care experience. 2 years management experience. Experience working with teams in a matrix organization.
Life sciences degree OR nursing qualification. 5 yrs experience in Clinical Project Management. Experience of International Clinical Trials. Bid Defense activity experience. Leadership and line management experience. Therapeutic experience in respiratory, reproduction and ophthalmology.
3+ years experience in a leadership/management role. Knowledge of related regulations including NCQA, HIPAA, CMS. Bachelors degree or above in a related field such as Nursing, Health Care Management, or Teaching. Proficiency in Excel, Word and Adobe Acrobat.