- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management,… more
- Centene Corporation (Harrisburg, PA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... REMOTE/WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS BEHAVIORAL HEALTH UTILIZATION MANAGEMENT.** **APPLICANTS MUST EITHER HOLD AN ACTIVE PA LICENSURE;… more
- UnityPoint Health (Cedar Rapids, IA)
- …Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a ... coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions to improve...and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you… more
- Children's Mercy Kansas City (Kansas City, MO)
- …within 4 years of hire + 1-2 years experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of...Missouri required upon hire + One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas… more
- Centene Corporation (Phoenix, AZ)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician...license as a Registered Nurse OR a current Texas Licensed Vocational Nurse. B. Training and Experience: Three years… more
- UNC Health Care (Kinston, NC)
- …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience preferred. + Minimum 1… more
- AmeriHealth Caritas (LA)
- …Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...Nursing (required) or Bachelor Degree in Nursing (preferred) + Licensed Social Work candidates: Master Degree in Social Work… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... + Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of… more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. Summary: This position facilitates utilization management processes to support the right care is provided at the ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… more
- Prime Healthcare (Ontario, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236094/ utilization - review -nurse-lvn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... to Self-Funded Plan. Qualifications Required qualifications: + Possess an active CA Licensed Vocational Nurse (LVN) license. + Minimum (2) two years of experience… more
- Helio Health Inc. (Syracuse, NY)
- …preferred. + Licensed /credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Wellpath (Lemoyne, PA)
- …The Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and ... lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical… more
- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Amergis (Santa Rosa, CA)
- The Licensed Clinical Social Worker collaborates with the multi-disciplinary team to provide input in the development of the plan of care for those patients/clients ... requiring social work intervention. The Licensed Clinical Social Worker provides counseling and crisis intervention to patients/clients who have social or emotional… more
- Dartmouth Health (Lebanon, NH)
- …leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote * ... Area of Interest:Nursing * Pay Range:$79,747.20/Yr. - $127,587.20/Yr. (Based on 40 hours per week, otherwise pro rata) * FTE/Hours per pay period:.01 hrs/per week (per diem/temp) * Shift:Rotating * Job ID:35880 Dartmouth Health offers a total compensation… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- Katmai (Fort Carson, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- University of Virginia (Charlottesville, VA)
- …that blends clinical expertise with system-level innovation. As a_ **_Medication Utilization Strategy Pharmacist_** _, you'll help design how medications are managed ... formulary compliance._ + _Drive system-level strategies that improve medication utilization and operational excellence._ **_Ideal Candidate_** + _Clinical experience… more
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