- George C. Grape Community Hospital (Hamburg, IA)
- Quality / Utilization Review Nurse Position Summary: The Quality / Utilization Review Nurse is responsible for evaluating the medical ... years of clinical nursing experience (acute care preferred). o Prior experience in utilization review , case management, quality improvement, and infection… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to...Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- Summary The Orlando VA Medical Center is seeking a Utilization Review Registered Nurse to join the Orlando VAMC team. The Utilization Review ... orientation, competencies and providing quality improvement and outcomes utilization consultation. Responsibilities The Utilization Review Registered… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …needs and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for ... evidence-based practice * Quality of Practice*: * Promotes quality through evidence-based utilization review ... issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)*… 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,...the plan of care and services provided are patient-focused, high- quality , efficient, and cost-effective. Serves as a preceptor and… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- YesCare Corp (Brentwood, TN)
- …best practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. + Track, trend and evaluate ... review . + Track, trend and evaluate appropriateness and quality of care issues with the implementation of education...license + No less than 5 years' experience in utilization management, case management, quality management. +… 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... of high quality , cost efficient medical outcomes for those enrollees with...retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- CDPHP (Latham, 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 ... + Minimum two (2) years of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. +… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... to status issue queries from patient financial services, coders, Quality and other entities. 10. Responsible for summary reports...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... development and ongoing implementation of QM Work Plan activities. . Improve quality products and services, by using measurement and analysis to process, evaluate… 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 ... use of resources; promote quality patient care; assist with patient care management; comply...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… 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 ... use of resources; promote quality patient care; assist with patient care management; comply...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… more
- Avera (Sioux Falls, SD)
- …the Clinical Appeals Specialist to ensure tracking and trending of all Utilization Review related denials/appeals are appropriately documented. + Assists with ... Utilizes third party clinical guidelines for level of care reviews (first level review ), and refers cases to the internal or external physician advisor for… more
- Ventura County (Ventura, CA)
- …the general and specialized principles, practices, techniques and methods of utilization review /management, discharge planning or case management. + utilize ... Senior Registered Nurse - Hospital Management Utilization Print...services for patients/families; + Conducts daily clinical reviews for utilization / quality management activities based on guidelines/standards for… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review...strategies for follow up in issues related to over/under utilization , high cost, high volume, quality and… more