- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Trinity Health (Troy, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to...(Outlined in Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education:… more
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is in person / on site. Please read below ... 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse :** . **...in Texas . 2 to 3 years of clinical nurse /case management experience . 2 to 3… more
- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... the areas of utilization criteria, appeal and review process, and case management system documentation....staff **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer… more
- Catholic Health (Buffalo, NY)
- …with Weekend and Holiday Rotation Hours: 8:00 am to 4:00 pm Summary: The Registered Nurse (RN) Care Manager- Utilization Review , as an active member of the ... Management and interdisciplinary care team, provides comprehensive Utilization Review and discharge services to patients...Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- Ascension Health (Baltimore, MD)
- …the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . ... **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- HCA Healthcare (Nashville, TN)
- …2-4 years nursing or behavioral health experience required + 1- 3 years relevant case management / utilization review experience preferred + Must hold and ... **Introduction** Do you have the career opportunities as a Behavioral Health Utilization Review Specialist you want with your current employer? We have an… 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...required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse (RN)… 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… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage ... with occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse (RN)...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… 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 ... the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
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