The UM Nurse Specialist conducts clinical reviews to ensure that services provided to members meet clinical criteria and are delivered in appropriate settings. Using clinical expertise, coordinates, documents, and communicates all aspects of utilization and benefit management, handling both prospective (pre-service and concurrent) and retrospective care reviews. They assist providers and members in coordinating care with in-plan providers and preferred out-of-plan providers.
Leads a team of clinical staff responsible for delivering high-quality, efficient, and patient-centered virtual imaging support. This role blends operational oversight, people leadership, and clinical expertise to ensure the team meets performance, quality, and service standards aligned with Included Health’s values. As part of a broader care coordination function, the team manages internal and external referrals for specialty and imaging orders.
Registered Nurse (RN) needed to join the Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.
We are seeking a Compassionate and Adult ADHD Experienced Provider to Join our Team at Mindful. Conduct ADHD Evaluations and provide On-Going Patient Management. Comfort working independently as well as with the Mindful team and operating in a fast-moving, high-growth environment is important.
You will virtually visit with members within Wyoming and conduct a virtual health risk assessment including an evaluation of past medical history, review of systems, medication reconciliation, and a wellness exam. This evidence-based practice screening will include point-of-care testing (as appropriate), the identification of diagnoses to be used in care management and active medical management in the furtherance of treatment. You will formulate a list of current and past medical conditions using clinical knowledge and judgment.
As a Psychiatric Mental Health Nurse Practitioner (PMHNP) with Backpack Healthcare, you’ll provide high-quality, compassionate psychiatric care to children, teens, and young adults through a collaborative telehealth model. Responsibilities include conducting psychiatric evaluations, developing treatment plans, prescribing medications and providing therapy.
As a care navigator, you build relationships with patients based on trust, utilizing motivational communication techniques, to help drive positive health behavior change and improved patient outcomes. You will triage vital signs and use this data to promote positive lifestyle and health behavior changes and provide wellness calls with patients to outline patient-centric goals and action plans.
The UM Integration Nurse will work as part of the Care and Case Management team, focusing on projects and work that integrate Utilization Management (UM) with Care and Case Management (CCM). This role is ideal for a nurse who can effectively bridge these two critical areas by communicating, coordinating, performing benefits verification, and conducting care coordination calls. Display focus towards continuous improvement, suggest alternative solutions, improve team productivity and member experience.
Looking for Nurse Practitioners aligned with Harm Reduction principles and experience prescribing buprenorphine-based medications for opioid use disorder in an outpatient setting. This is a fully remote, full-time, W2 position. You’ll work directly with patients in a structured, fully remote environment, supporting recovery in alignment with harm reduction principles.
The Care Coordinator facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions and cost effective delivery of quality care and services across the continuum. They collaborate with the interdisciplinary care plan team to address care issues and specific member needs, whether medical, behavioral, social, community based or long term care services. This role coordinates the care of individual clients with identified populations.