- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review ...+ Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time ... Posted:April 28, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate… more
- Alameda Health System (Oakland, CA)
- … Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… 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** ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West...by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data… more
- AmeriHealth Caritas (Charleston, SC)
- …. **Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care… more
- Elevance Health (Walnut Creek, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** Virtual: This role enables associates...Skills, Capabilities, and Experiences** **** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- HCA Healthcare (Alexandria, LA)
- …need:** + Registered Nurse + Registered Nurse Diploma, or Associate Degree + Utilization Review and coding experience preferred + Demonstrated ability to develop ... **Description** **Rapides Regional Medical Center** **RN Clinical Reviewer ** **PRN** Rapides Regional Medical Center is committed to investing in the latest… more
- Matrix Providers (Aurora, CO)
- … management , utilization review or case management . Licensure/Registration: Current, full , active, and unrestricted license to practice as ... Utilization Review Nurse (RN) Location: Aurora,...Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education: Bachelor-s degree in nursing.… more
- Elevance Health (Los Angeles, CA)
- …license, especially in Florida, Georgia, Indiana, and/or Kentucky. + Experience in utilization management and/or reimbursement coding for genetic testing. + ... **JR147375 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...**Location:** Virtual: This role enables associates to work virtually full -time, with the exception of required in-person training sessions,… more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- Humana (Columbus, OH)
- …. At least 2 years of experience post-training providing clinical services . Experience in utilization management review and case management in a health ... physicians to explain the rationale behind utilization management decisions, + Work includes computer-based review ...a good faith estimate of starting base pay for full time (40 hours per week) employment at the… more
- Katmai (Fort Carson, CO)
- …+ Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full , and unrestricted Registered Nurses ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- AmeriHealth Caritas (Dover, DE)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... times, quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… 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
- Tenet Healthcare (Detroit, MI)
- …and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of ... initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations...: Detroit Medical Center Shared Services Job Type: : Full -time Shift Type: : Days : : Req ID:… 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
- Beth Israel Lahey Health (Burlington, MA)
- …the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Recovery Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full -time Utilization Review Specialist Shift/schedule: Monday-Friday, ... by Supervisor, supporting the agency's mission and client care quality. Department Utilization Review Employment Type Full -Time Minimum Experience Mid-level… more
- Trinity Health (Mason City, IA)
- …with members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to inform them ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:**... time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case… more
- Prime Healthcare (Garden Grove, CA)
- … utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone ... Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Utilization review tech essentially works to… more