- AmeriHealth Caritas (LA)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...Management Department to facilitate timely discharge planning.. Reports to: Director , Case Management What we offer Fundamental to providing… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Current driver's license required… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
- CVS Health (Boise, ID)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and plan language or… more
- Actalent (Sunrise, FL)
- …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… 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 ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director ; be able to identify, analyze and make… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director , Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… 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 Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management Team consisting… more
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... We are looking for a Utilization Management RN, to join us in leading...and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is...which have been referred to the physician for peer-to-peer review with the Medical Director of the… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- CVS Health (Charleston, WV)
- …, **evidence-based clinical criteria** , and **clinical practice guidelines** to review and authorize services requiring precertification. Most of the work is ... in this role determine service authorization or escalate cases to a Medical Director when necessary. This is a **sedentary role** , requiring extended periods of… more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... and quality of care and communicates findings to the director of the department. + Maintains current knowledge of...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- Holzer Health System (Gallipolis, OH)
- …organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management. Partners with Social Workers to refer ... Works under the supervision of the Director of Care Management. Reviews the medical record...taken into consideration. . Professional experience with case management, utilization review , or discharge planning highly desirable.… more
- Texas State University (Round Rock, TX)
- Posting Information Position TitleDirector of Simulation Laboratory / Clinical Nurse Faculty (Open Rank) Job Posting Number2025042NTL Job LocationRound Rock ... School of Nursing (http://www.nursing.txstate.edu/) at Texas State University is seeking a Director of the Simulation Laboratory. This key role will be responsible… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the...and clinical areas under the direction of the Executive Director and the VP of Revenue Cycle/Chief Revenue Officer… more