- buyer (New York, NY)
- …the Children's Special Services Department and provides a hybrid approach, including utilization and case management, to support members aged 0-21 years with complex ... issues. The Children's BH CM is responsible for conducting utilization and quality management activities in accordance with New...and Transitioning Aged Youth (TAY) and coordinates with Children's Nurse CM and Foster Care Liaison, as indicated, to… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the ... an expert level at all objectives delineated in the Utilization Review Nurse and Utilization ...concern that may require clinical review during the pre-bill, audit , or appeal process. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Expands… more
- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent ... best and most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers,… more
- Elevance Health (Mason, OH)
- ** Nurse Audit Senior (Operating Room)** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is determined to recover, eliminate and prevent unnecessary medical-expense spending." The ** Nurse Audit Senior** is responsible for identifying, monitoring, and… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Molina Healthcare (GA)
- …in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), ... more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition… more
- Guthrie (Binghamton, NY)
- Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and ... CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Bachelor's Degree in Nursing; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) ... acute care or clinical experience in area of specialty. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** + Master's… more
- McLaren Health Care (Mount Clemens, MI)
- …6. Provides support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process are met, including ... sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and… more
- State of Massachusetts (Westborough, MA)
- …the highest quality, and delivered in a cost-effective manner. This position will audit , inspect, and train MassHealth providers and integrated care plans as well as ... clinical support to OLTSS staff who manage those programs. Additionally, the nurse will provide input on cross-cutting clinical initiatives affecting LTSS programs.… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- …departmental staff to ensure compliance with Telehealth protocols and standards. Analyze audit results to identify areas for improvement, and present findings in ... career advancement. 9. Resource and Safety Management: Identify and assess resource utilization and safety issues, and take appropriate actions to address them. 10.… more
- Beth Israel Lahey Health (Cambridge, MA)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... performance is evaluated using the Inpatient Case Manager Guidelines and audit tool. Reports to Inpatient Case Management Supervisor. **Job Description:** **Primary… more
- STG International (Temple, TX)
- STGi is currently seeking a Pharmacy Nurse -Licensed Vocational Nurse to provide services at The William R. Courtney Texas State Veterans Home. The William R. ... drug regimen and report irregularities to DON 15. Randomly audit drug storage and medical supply areas to ensure...care in pharmacy ordering, alternative substitutions and off formulary utilization . 25. Participates as a team member in the… more
- Elevance Health (Macon, GA)
- ** Nurse Case Manager Senior - Field Nurse ** **Work location:** This field-based role located in the Macon, GA area enables associates to primarily operate in the ... 1 late evening shift 11:00am to 7:30pm EST. The ** Nurse Case Manager Senior - Field Nurse **...promote culturally responsive care. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings,… more
- HCA Healthcare (Richmond, VA)
- …We care like family! Jump-start your career as a Clinical Research Nurse today with Chippenham Hospital. **Benefits** Chippenham Hospital offers a total rewards ... for benefits may vary by location._** Come join our team as a Clinical Research Nurse . We care for our community! Just last year, HCA Healthcare and our colleagues… more
- Molina Healthcare (Warren, MI)
- …decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides ... of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Banner Health (Scottsdale, AZ)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Genesis Healthcare (Camp Hill, PA)
- …Nursing Supervisor, Unit Manager, ADON or ADON - Unit, or Director of Nursing ( Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing ... satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care to LPNs and CNAs… more
