- Commonwealth Care Alliance (Boston, MA)
- …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Battelle Memorial Institute (Norfolk, VA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...data relevant to primary health assessments including a detailed medical history to develop time sensitive treatment plans which… more
- Luke Staffing (Glendale, CO)
- …in accordance with VA and community care guidelines. . Perform clinical review of incoming medical records, documenting communication with ordering providers ... **REGISTERED NURSE ** **SITE OF SERVICE:** Department of Veterans Affairs,...standards of care, and national accreditation requirements. **DUTIES:** **Clinical Review & Coordination:** . Review consults and… more
- ERP International (Camp Pendleton, CA)
- **Overview** ERP International, LLC is seeking a **Licensed Vocational / Practical Nurse ** for a full-time position supporting the **Branch Health Clinics** at ... Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays!** Medical /Dental/Vision, STD/LTD/Life, and Health Savings Account available!** Annual CME Stipend and… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Health Educator** supporting **Naval Medical Center San Diego, CA ... Benefits!** Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays!** Medical /Dental/Vision, STD, LTD and Life Insurance, Health Savings Account available, and… more
- Katmai (Fort Carson, CO)
- …same duties as those required of any military or government civil service nurse of similar experience and in similar duty assignments. **ESSENTIAL DUTIES & ... and physical protection of patient information. + Generate and maintain proper medical records on beneficiaries to whom treatment is provided in accordance with… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy ... by identifying and updating appropriate procedure and diagnosis codes for company medical policies and UM ( Utilization Management) guidelines that reflect … more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
- Stanford Health Care (Palo Alto, CA)
- …development of their APPs. The Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse ... the clinical, operational, and administrative initiatives of the service line Medical Director and unit nursing management team. . Conduct regularly scheduled… more
- Stanford Health Care (Palo Alto, CA)
- …growth and development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered ... the clinical, operational, and administrative initiatives of the service line Medical Director and unit nursing management team. + Conduct regularly scheduled… more
- Teleflex (Boston, MA)
- …:13056 **Interventional -** The Interventional business unit at Teleflex offers innovative medical devices that are used to diagnose and treat coronary and ... a dynamic, growing team that offers healthcare providers an array of medical technology solutions that make a difference in patients' lives. **Position Summary**… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes + Coordinate: Ensures ... results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Stony Brook University (Stony Brook, NY)
- …as a healthcare provider in the state of New York (eg, physician, nurse practitioner, or registered physician assistant or equivalent). Five (5) years of full ... partners such as University Police to develop and implement integrated medical and behavioral health initiatives that incorporate principles of cultural humility.… more
- Battelle Memorial Institute (Columbus, OH)
- …+ Under the supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health ... psychophysiological tests and assessments under the supervision of a licensed medical /mental health professional + Populate and maintain a computerized database… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, ... changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION II: ... UTILIZATION REVIEW NURSE SUPERVISOR...for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- Summary The Orlando VA Medical Center is seeking a Utilization Review Registered Nurse to join the Orlando VAMC team. The Utilization Review ... improvement and outcomes utilization consultation. Responsibilities The Utilization Review Registered Nurse leads the integration of evidence-based… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II...over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, ... Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88… more
