- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform...preferred, Six Sigma Green Belt preferred · Valid Registered Nurse (RN) preferred PHYSICAL DEMANDS: -Lift/position up to 25… more
- Elevance Health (Woodbridge, VA)
- RN Utilization Review Nurse (Washington DC Medicaid) JR149756 **Location** : This role requires associates to be in-office 4 days per week, Monday - ... located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... functions for assigned sites. + Collaborate with the director to develop and implement quality review ...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- AmeriHealth Caritas (Dover, DE)
- …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
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals… more
- Trinity Health (Des Moines, IA)
- …**Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim assignment? Join Trinity Health 's ... and organizational goals. **MINIMUM QUALIFICATIONS:** + Current Iowa License Registered Nurse or Social Worker + Master's degree in healthcare related field… more
- Prime Healthcare (Ontario, CA)
- …licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176615/ utilization - review - nurse ... to the Referral Technicians with regard to referral distribution and tracking. Assists Director of UR Dept. in providing oversight and monitoring productivity of UR… 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
- Mount Sinai Health System (New York, NY)
- …influence other services by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data collection, data received ... **Job Description** The Assistant Director of Case Management supports the Director...the delivery of comprehensive front-line Case Management services, including utilization management, care facilitation and discharge planning. The Assistant… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... market. Must be located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll… more
- Intermountain Health (Murray, UT)
- …responsible for the development, implementation, evaluation, and operational management of utilization review programs to include prior authorization, acute and ... + Oversees program components related to care management and utilization review for the specific line of...Bachelor's or master's degree in clinical specialty, such as Nurse , LCSW, Nurse Practitioner, Physician's Assistant, Physical… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/ director -of-case-management utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital… 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 (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Ascension Health (Nashville, TN)
- …date required. American Heart Association or American Red Cross accepted. + Registered Nurse obtained prior to hire date or job transfer date required. Education: + ... Bachelor's degree in nursing or diploma from an accredited school/college of nursing required. Master's degree or combination of Bachelor's degree and experience preferred. Work Experience: + 5 years of experience required. + 10 years of experience preferred.… more
- Katmai (Fort Carson, CO)
- …Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,...licensed in Colorado, be able to practice using a nurse compact state license or have a license from… 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
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