The Utilization Management Nurse is responsible for handling authorization requests, reviewing requests for medical necessity and plan coverage, managing provider communications, and ensuring accurate data entry of coding and provider information. This position requires knowledge of clinical terminology, basic nursing, attention to detail, and the ability to manage multiple tasks in a fast-paced environment.
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This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. This role is based in our Dubuque office and is also available remotely within Iowa.
Processes, tracks and appeals clinical denials and supports the design, development and implementation of Utilization Management data collection methodologies. Displays and analyzes data to identify trends and works collaboratively to develop plan of action.
We are looking for a Psychiatry Advanced Practice Provider who will provide clinical evaluation and medication assessment to students who use the TimelyCare platform. Candidate must be willing to work Monday - Friday Noon - 8pm PST and must have a current license to practice in the state of California.
As a Mobile Research Nurse, you will play a crucial role in ensuring the successful execution of research studies. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your caring nature will help maintain compliance with each study's protocol.
Weβre hiring a Nurse Practitioner licensed in California to support Medicare and Medicaid members. This is fully remote work, with flexible scheduling (minimum 24 hours/week). Youβll focus on Medicare Annual Wellness Visits, risk adjustment, and HEDIS care gap closure β no travel, no micromanagement, just meaningful clinical work from home.
The RN (Psychiatric) Field Representative surveys health care organizations throughout the United States. Applies systems analysis skills and inductive reasoning skills to determine health care organizations' degree of compliance with applicable standards and functionality of care delivery systems. Engages health care organization staff in interactive dialogues on standards-based issues to assess compliance. Prepares management reports that clearly link individual standards deficiencies with potential systems vulnerabilities and related organization risk points.
This is an in-person position where you will provide high-quality, patient-centered, comprehensive primary care services to patients residing in SNFs. Responsibilities include rounding and managing clinical care, prescribing medications and treatments, and timely documentation using Theoriaβs EHR system. The provider will be available for phone/secure messaging consultations with facility nursing staff.
Performs physical assessments of the patient, reviews their medical history, and interprets diagnostic tests/results in order to provide effective treatment. Conducts preventive health screenings based on the patient's age, history, and unique needs to provide proactive health care. Educates patients and their family about medical conditions, treatment, and follow-up.
Provide virtual telehealth services by conducting video visits to assess patient needs, gather clinical history, diagnose, and provide clinical guidance. Serve as a consultant with the Care and Case Management program, managing a panel of primary care patients and collaborating with physicians to improve health outcomes and quality. You will maintain patient satisfaction and protect patient's medical information.