- GHR Healthcare (Atlanta, GA)
- …making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare ... area (PA,NJ) Pay Rate: 37.50 -40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient services… more
- Staffing Now (Norfolk, VA)
- …outpatient precertification, prior authorization, and post service requests.Refers cases requiring clinical review to a Nurse reviewer.Responsible for the ... and written inquiries from clients, providers and in-house departments.Conducts clinical screening process.Authorizes initial set of sessions to provider.Checks… more
- Staffing Now (Nashville, TN)
- …outpatient precertification, prior authorization, and post service requests. Refers cases requiring clinical review to a Nurse reviewer. Responsible for the ... and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …organizational standardization. Participates in identifying expanded use of and improvement management utilization of NGHS continuum. Participates in identifying ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted...day operations of the department by supporting the case management and interdisciplinary healthcare team in facilitating patient care… more
- Cambia Health Solutions, Inc (Lewiston, ID)
- Care Management Nurse (Future Opportunities)Work from home within Oregon, Washington, Idaho or Utah *Please be advised that this role is part of our candidate ... easier and lives better. As a member of the Clinical Services team, our Care Management RN's...Degree in Nursing or related field3 years of case management , utilization management , disease … more
- US Tech Solutions, Inc. (Columbia, SC)
- …. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... using the individual patient's benefits contract and our medical policies. The nurse would read through clinical information, ensuring that all requirements… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …conflicts as they occur. With support from Charge Nurses and Educators, the Nurse Manager directly supervises the clinical nursing and ancillary nursing ... and must exercise sound, independent judgment in adapting and applying leadership and clinical principles to specific situations. The Nurse Manager relies on… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …members as needed to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure patients ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia...patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team… more
- PrideStaff (Wilmington, DE)
- …in care and Annual Wellness Visits. QUALIFICATIONS Licensed and credentialed Registered Nurse 3-5 years' experience in a clinical or community health ... Job Title: Nurse Navigator Location: Wilmington, DE Schedule: Monday -...performance. RESPONSIBILITIES Promote timely access to appropriate care. Increase utilization of preventative care. Reduce emergency room utilization… more
- Engage Partners, Inc. (Orange, CA)
- …based, trauma informed, and culturally competent services. Ensure charts meet quality management standards per monthly utilization review and/or chart review ... The Nurse Supervisor supervises and manages nursing staff to...in a timely manner. Responsible for direct report performance management including, performance improvement plans, formal written warning notices.… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted in a foundation of improving the health of our ... all campuses operated by NGHS. Collaborates with the physicians, patients, families, nursing, utilization review and other members of the health care team to ensure… more
- Pacer Staffing (Atlanta, GA)
- …description Job Summary This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and ... Nurse , with current unrestricted license in appropriate state . 4+ years Utilization Management experience . Proficient at in-depth analysis of clinical … more
- Blanchard Valley Hospital (Findlay, OH)
- …REQUIRED QUALIFICATIONS Licensed by the Ohio Board of Nursing as a Registered Nurse . Four (4) years clinical nursing experience. BCLS certification required ... Manager is to develop, implement and evaluate an organized inpatient case management service for pediatric and adult hospitalized patients under the direction of… more
- Pacer Staffing (Atlanta, GA)
- …regulatory requirements, and HIPAA privacy regulations. . Thorough knowledge of Case Management , Utilization Management , HIPAA Privacy and Security ... (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and...in a NCL state . Minimum of three years clinical experience . Experience in case management ,… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …to help management determine long term focus.Meets routinely with Clinical Coordinator, Nurse Manager, House Coordinators, Medical Director and Manager ... identify areas of further savings.Assist Clinical Coordinator with FTE utilization and management .Serves as primary liaison between referral sources of… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category: Clinical Support Work Shift/Schedule:12 Hr Evening - MorningNortheast Georgia Health System is rooted in a foundation of improving the health of our ... meet established metrics, improve handoffs, reduce daily crisis regarding bed management , improve overall flow and drive the throughput policies and procedures.… more
- ProKatchers (Bronx, NY)
- …and from internal and external destinations as appropriate and required; assists clinical personnel in transferring patient's to and from assigned departments as ... and/or immediate or additional attention, informing the ADN, Head Nurse of such situations. Assist patient with ADLs (ie...ADLs (ie shaving) as needed and when directed by clinical staff. Performs CPR as needed. Identifies patient characteristics… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, ... safety net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the … more
- Humana (Louisville, KY)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...restriction. + Minimum 1 year in-hospital Utilization Management experience + Minimum 2 years Progressive clinical… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... Communities is good for the Soul. Join Us!** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical… more
