- Veterans Affairs, Veterans Health Administration (Houston, TX)
- …standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management, Nurse Case Manager ... Summary The Registered Nurse Utilization Management Registered Nurse...criteria to perform basis review while developing technical and clinical competencies. The Nurse is a novice… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- US Tech Solutions (Columbia, SC)
- …sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy experience + A typical ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management/ clinical /or combination; 2 of 4 years… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for the ... stays and documents the interactions. + Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning and monitors quality assurance for Lahey… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation for centrally authorized services.… more
- UNC Health Care (Chapel Hill, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Experience in HEDIS, MIPS, PQRS, ACO, STARS preferred… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager * PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... and harassment in employment." **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:**… more
- CareFirst (Baltimore, MD)
- …approved claims. + Prepares retrospective reviews, case appeals, billing coordination, and clinical support. + Manages the analysis of utilization patterns, such ... to the required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership… more
- Covenant Health (Nashua, NH)
- …and procedures. + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory learning ... work remotely as needed Education and Experience + Registered Nurse licensed in New Hampshire required + Minimum of...New Hampshire required + Minimum of five years broad clinical experience preferred + Case management and/or Utilization… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/appeals oversight. Participates in department and hospital performance… more
- Alameda Health System (Oakland, CA)
- Clinical Nurse IV - (Assistant Nurse Manager ) - Labor & Delivery - (L&D) + Oakland, CA + Highland General Hospital + Labor and Delivery + Full Time - ... degree in Nursing preferred. Minimum Experience:One year full-time, continuous experience as a Clinical Nurse III or three years experience as a Clinical… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... experience required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
- Baystate Health (Springfield, MA)
- …a nationally recognized leader in healthcare quality and safety, is looking for a** ** Clinical Nurse Manager ** **to join our** **Home Health** **team!** ... and timely care delivery of an interprofessional staff in collaboration with all clinical manager partners. Leads an interprofessional approach to care planning,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... status and continued patient stays with Attending Physician, Physician Advisor, Inpatient Nurse Care Manager , and insurance/payer. + Collaborates with Revenue… more