Nurse jobs in the Insurance industry

WHY STATE FARM? Our commitment to customers makes us the No. 1 insurer of cars and homes in the United States and an insurance leader in Canada. The same commitment to our workforce is how we got here and how we stay here. Our 90-year track record highlights State Farm as an employer of choice committed to providing career opportunities that last a lifetime. From diverse backgrounds and talent, to...
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Position ID:29077 Position Title: Utilization Review Nurse I Min Education Desired: Associates Degree Travel Percentage:Minimum Relocation:No Job Summary: The Utilization Review Specialist performs telephonic review of clinical services. This review will determine the medical necessity as well as alternative levels of care, utilizing clinical expertise, judgment and established criteria....
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Responsible for safely and effectively transitioning Molina members from acute or inpatient care to lower levels of care and/or home in a cost efficient manner. Provides assessment, planning, implementation, coordination, monitoring, and evaluation of services for Molina members as they transition care and follows them for at least 30 days. Conducts an onsite hospital discharge visit and a post-di...
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POSITION SUMMARY: Manages submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members and related outside agencies as a part of the integrated Healthcare Services Team. Conducts pertinent research, evaluates, responds and completes appeals and other inquiries accurately, timely and in accordance with all established regulatory guidelines. Prepares appeal s...
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Job Description Job Summary Responsible for safely and effectively transitioning Molina members from acute or inpatient care to lower levels of care and/or home in a cost efficient manner. Provides assessment, planning, implementation, coordination, monitoring, and evaluation of services for Molina members as they transition care and follows them for at least 30 days. Conducts an onsite hospital d...
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Location: Irving, TX This is a non-remote position Job Summary Responsible for overseeing the Integrated Case Management staff focused on assisting Molina Healthcare members with their health care needs to achieve optimal clinical, financial and quality of life outcomes. Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provided and o...
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