- Actalent (Fort Lauderdale, 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...reports on department activities as assigned. Essential Skills Clinical review Utilization review Utilization… more
- Thomas Jefferson University Hospitals, Inc. (Philadelphia, PA)
- …providers, members and interdepartmentally. Serve as resource for physicians, PCPs, Utilization Review departments and all medical providers. Identify trends ... Job Details The Utilization Management Nurse is responsible assure...nursing in the Commonwealth of Pennsylvania 2 years medical/surgical, utilization review and emergency room experience. BSN… more
- FROEDTERT HEALTH (Milwaukee, WI)
- …Refers cases to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary team as it ... Minimum of 3 years of acute care nursing experience is required; Prior utilization management or case management experience is required. A minimum of 5 years… more
- McLaren Health Care Corporation (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...working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier… more
- Blue Shield of California (El Dorado Hills, CA)
- …Services department including concurrent review , transplant and NICU/HROB. The Manager, Utilization Management Nurse Management will report to the Director, ... are met for all lines of business including Commercial, Medicare , and Medi-Cal Collaborate across functional departments to improve...least 2 years of prior relevant experience in transplant utilization management review About the Team About… more
- MediTelecare (York, PA)
- …writing orders for medications, as appropriate Participate in case reviews, consultations and utilization review Respond to urgent calls from the facility and ... to clients in long term care facilities as a Nurse Practitioner (NP) with MediTelecare, the nation's largest telehealth...and your assigned facilities Able to become credentialed with Medicare and Medicaid, and other payers as necessary Geriatric… more
- UHS (Riverside, CA)
- …required, Bachelor's preferred. Minimum 3 years' experience in Medical Management ( Utilization Management, Appeals and Grievances, and/or Concurrent Review ). ... Responsibilities SUMMARY: The Delegation Oversight Nurse performs activities to assure compliance with Health...with Federal and State laws and regulations (Centers for Medicare and Medicaid Services, Department of Managed Health Care,… more
- CentraState Healthcare System (Freehold, NJ)
- …in care and management of inpatient hospitalized patients. Experience in acute care utilization , preferred. Utilization review or case management training ... Overview Emergency Department (ED) Nurse Care Manager is responsible for establishing, coordinating,...Data and computer skills Knowledge of relevant and state utilization review and appeals requirements About Us… more
- WellSpan Health (York, PA)
- …and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation ... management of patient care between visits. Assists in the management of patient utilization of health care system and provides patient education relative to health… more
- Southern Oaks Care Center (Pawnee, OK)
- …Functions Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. Ensure that ... (RAI) process. Ensure that all resident rooms, common areas, treatment areas and nurse 's stations are maintained in a clean, safe and sanitary manner. Assist to… more
- DHR Health (Edinburg, TX)
- … Medicare and Medicaid guidelines and regulations pertaining to utilization review and discharge planning. Responsibilities: POSITION RESPONSIBILITES: Assists ... time. Proceeds to issue Hospital Issued Notice of Non-coverage and Hospital Requested Review for Medicare patients according to policy. Refers cases not meeting… more
- Molina Healthcare (Long Beach, CA)
- …by the Chief Medical Officer. Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Regal Medical Group, Inc. (Northridge, CA)
- …issues, as well as care coordination issues. Oversight of the professional claims review nurse team (nurses/coders), who work with the claims department to ... Director, Prior Authorization Clinical RN is to manage the prior authorization nurse case managers and support staff (coordinators), professional claims review … more
- CenterWell Primary Care (Decatur, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Kaiser Permanente (Decatur, GA)
- …in an acute care setting. Minimum two (2) years of experience in utilization review , case management, and discharge planning preferred. Bachelors Degree in ... quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review , monitoring for inefficiencies and opportunities to… more
- Magellan Health, Inc. (San Diego, CA)
- …care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity ... care plans for high and moderate stratified members in the Medicaid, Medicare , and Whole Health markets. Possesses clinical knowledge, understands best practices and… more
- Wealthy Group of Companies LLC (Overland Park, KS)
- …(notMedicare/Medicaid) with a deep understanding of addiction treatmentoperations, including utilization review and management. Skills :Exceptional financial ... manage budgets and understand keyfinancial metrics, strong fluency in utilization review andmanagement (including medical necessity documentation,… more
- HC&N Healthcare Solutions (Miller Place, NY)
- …identify trends on a monthly basis Responsible for timely and accurate completion of Utilization Review and Triple Check Serves on, participates in, and attends ... Demonstrates an understanding of MDS requirements related to varied payers including Medicare , Managed Care and Medicaid Ensures timely electronic submission of all… more
- Main Line Health (Broomall, PA)
- Description: Could you be our next Clinical Reimbursement Manager- Utilization Review at HomeCare & Hospice? Why work as a Clinical Reimbursement Manager with ... Manager reviews all clinical assessment (OASIS) documentation and assess appropriate visit utilization patterns based on the care needs of the client and the… more
- HOSPICE OF THE CHESAPEAKE (Pasadena, MD)
- …$105500.00 Salary/year Travel Percentage Up to 25% Job Shift Day Job Category Nurse Description We are currently seeking a dedicated, compassionate Nurse -Leader ... quality of patient care through direct staff observation and review of nursing documentation, review of medical...of the team budget to provide efficient and cost-effective utilization of resources. Other duties as assigned by the… more
