- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...and may be implemented in the future._ **Position Level** Manager **Country** United States of America At Huron, we're… more
- Vighter Medical Group (Glendale, CO)
- …team at theOffice of Community Care (OCC)in Glendale, Colorado.As aCase Manager / Utilization Review Nurse , you'll play a key role in coordinating and ... Registered Nurse (RN) Glendale, CO Job Details Job Location...or on-call required. What You'll Do As a Case Manager / Utilization Review RN,...You'll Do As a Case Manager / Utilization Review RN, you will: + Conductclinical… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... this position is able to cover a multitude of utilization review functions through point of entry,...prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of ... Patient Accounting Centers (CPAC) for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to… 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** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Dignity Health (Chandler, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the...five (5) years of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the...five (5) years of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five...required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
- Prime Healthcare (Weslaco, TX)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/233537/registered- nurse -case- manager ... KNAPP MEDICAL CENTER IS LOOKING FOR A PRN REGISTERED NURSE CASE MANAGER TO WORK WEEKENDS. WE...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Integra Partners (Troy, MI)
- …in a payer or managed care environment. + Strong understanding of utilization review , authorizations, and appeals processes. + Excellent verbal/written ... The Utilization Management (UM) Nurse Supervisor is...leadership duties, serving as both a mentor and performance manager for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES… more
- Saint Francis Health System (OK)
- …reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to ... levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236088/rn-case- manager utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- CenterWell (San Juan, PR)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day ... US hospitals are four times designated. Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and … more