- Pomona Valley Hospital Medical Center (Pomona, CA)
- …education necessary to meet licensure requirements. One year experience in Utilization Review or Case Management discharge planning, current knowledge/use ... vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case Managers, support staff, insurance… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the...appeals. JOB RESPONSIBILITIES + Monitor incoming faxes + Enter UM authorizations review requests in UM ... HCPC codes + Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred + Knowledge of ICD-10, HCPCS… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt… more
- Sharp HealthCare (San Diego, CA)
- …roundsReviews every patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient identified per ... departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.Keeps SRS… more
- Tenet Healthcare (Detroit, MI)
- …of care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily, ... RN Utilization Review - Case Management -...an authorization process Closes open cases on the incomplete UM Census Completes the Medicare Certification Checklist on applicable… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review for medical… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Management. Your Responsibilities * Receive, research, prioritize and respond to Utilization Management, Case Management, Disease Management ( UM /CM/DM) requests ... apply specific guidelines, policies, and procedures as authorized by the clinical review areas and in coordination with UM /CM/DM activities. * Research… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... bonus not to exceed 10% of salary for this position. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Bakersfield, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Glendale, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Cedars-Sinai (Beverly Hills, CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Actalent (Santa Barbara, CA)
- …modalities, community standards, and professional nursing standards. Essential Skills + Utilization management and review experience. + Strong multi-tasking, ... Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services operational… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- Lawrence General Hospital (Methuen, MA)
- …acute care setting with discharge planning, continuing care, care management, and utilization review preferred. ? Strong verbal and written communications skills ... Job Description: The RN Care Coordinator is responsible for overseeing the appropriateness of...of the Hospital on a rotating basis to perform utilization reviews and other UM activities, as… more
- US Tech Solutions (Boston, MA)
- …& telephone to create an event or transaction by lines of business for the UM teams to review and decision requests + Contacts provider offices for further ... be directly associated with incoming referrals and authorizations for the utilization component of medical management. **Key Responsibilities/Duties - what you will… more
- University of Southern California (Alhambra, CA)
- …+ Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work ... The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of… more
- Rochester Regional Health (Rochester, NY)
- …Care Management Only: Supports manager in coordinating all activities related to Utilization Review throughout the hospital. Coordinates all concurrent and ... to accurately manage KRONOS entries, edits, report generation. Assist staffing coordinator with routine payroll functions. + Demonstrates knowledge and understanding… more
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