- Dignity Health (Bakersfield, CA)
- …review based on medical necessity. The position partners with both the Pre - Service and In-Patient Utilization Management teams. Ensures to monitor and ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Management NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of ... the UMN reviews service authorization requests to ensure appropriate service utilization . This includes reviewing specialties, medical treatments, elective… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- Summary The Utilization Management (UM) Registered Nurse (RN) is responsible and accountable for all elements of the nursing process when providing and/or ... , and customer satisfaction throughout the continuum of care. Responsibilities The Utilization Management (UM) Registered Nurse (RN) is responsible for providing… more
- Houston Methodist (Houston, TX)
- …eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and managed ... At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed...any denials to the appropriate case manager, denials, and pre -bill team members, as well as management .… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for ... payment review.) + Prompt, courteous, professional and error free in performing utilization management functions. + Available to answer inbound phone calls… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... is a registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of a targeted patient… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- Summary As the regional Revenue Utilization Review (RUR) Nurse Manager the incumbent is accountable to the Consolidated Patient Account Center (CPAC) Director, ... Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. You may be required… more
- Trinity Health (South Bend, IN)
- …test(s)/procedure(s). May prepare special reports as directed by the Manager to document utilization of the Pre - Service unit's services and patient flow ... entered on the wrong encounter. Validates complete and accurate documentation by Physician/ Utilization Management colleague is met prior to completing Bed … more
- Blue KC (Workman, MN)
- …area. **Job Description** + Conducts pre - service , concurrent and / or post- service utilization management reviews to ensure appropriate use of the ... Qualifications** + Bachelor's degree in nursing preferred. + 1+ year(s) of utilization review, disease management , and/or case management experience.… more
- Humana (Miramar, FL)
- …physician, referral source and provider interactions and communications. Work with Pre -Authorization, Utilization Management , Billing, Pharmacy, Home Care ... caring community and help us put health first** The Pre - Service Coordinator is responsible for all aspects... Coordinator is responsible for all aspects of referral management and accurately process incoming requests for homecare, DME/supplies… more
- Catalent Pharma Solutions (Philadelphia, PA)
- **Manager Pre -Production and Label Control** **Position Summary** Catalent, Inc. is a leading global contract development and manufacturing organization (CDMO) whose ... better and healthier lives. Catalent is dedicated to delivering unparalleled service to pharma, biotech, and consumer health customers, supporting product… more
- Houston Methodist (Houston, TX)
- …complex patients, receiving coaching from experienced Transplant Coordinators and management , benefiting from their practice. The Pre -Transplant Coordinator ... At Houston Methodist, the Pre -Transplant Coordinator position a registered nurse, responsible for participating in department initiatives, facilitating, and… more
- UNC Health Care (Goldsboro, NC)
- …accounts that require attention to Pre -Arrival Team Lead/Manager. 7. Notify Utilization Review & Case Management regarding any admissions that need Clinical ... **Description** Summary: The Pre - Arrival Authorization Specialist I will serve patients/customers...10. Abides by the UNC Health Wayne - Referral Management & Financial Clearance Collections Policies. 11. Uses professional… more
- Fresenius Medical Center (Decatur, GA)
- …SCOPE:** Supports the Organization mission, vision, core values and customer service philosophy. Adheres to the Organization Compliance Program, including following ... all regulatory and Organization policy requirements. Provides direct nursing care pre , during and post procedure, under the direction of the Facility Manager,… more
- Fresenius Medical Center (Richmond, VA)
- …AND SCOPE:** Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FVC/FMCNA Compliance Program, including following all ... regulatory and FVC/FMS policy requirements. Provides direct nursing care pre , during and post procedure, under the direction of the Facility Manager and/or Charge… more
- Sutter Health (Santa Rosa, CA)
- …manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid ... and fast-paced environment with changing business priorities. Organizational and time management skills, with the ability to prioritize multiple projects while… more
- UTMB Health (Friendswood, TX)
- …quality, cost, and service /outcomes. Supports and actualizes the UTMB Utilization Review/Case Management program by utilizing clinical knowledge, expertise, ... Management program to ensure high quality, cost effective service /outcomes, and a safe and efficient work environment. +...and completes a formal preceptor plan in accordance with Utilization Management Policy 09.04. + Identifies and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …care or health insurance environment. + Minimum 2 years of experience with pre -authorization, utilization review/ management , case management , care ... and goals. + Clearly and succinctly documents necessary and/or required information in Utilization Management system. + Monitors and complies with all state,… more
- University of Michigan (Ann Arbor, MI)
- …such as Allscripts + Participate in venues to reduce barriers to discharge ** Utilization Review and Utilization Management ** + Conduct clinical review ... Allscript + Identify opportunities for cost reduction and participate in appropriate utilization management venues + Conducts referrals and consultation with… more
- Northwell Health (Staten Island, NY)
- …another level of care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for ... management and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge planning, preferred. + Keeps… more