- 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 ... weekly inpatient unbilled accounts and meets organizational financial targets. Assures concurrent financial management of the patient's account focusing on… more
- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily...documents, and codes and reports the data to the Utilization Management Inpatient Coordinator and Inpatient Nurses.13.… more
- Centene Corporation (Sacramento, CA)
- …levels of care and facilities + Partners with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners ... findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and… more
- Centene Corporation (Tallahassee, FL)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- McLaren Health Care (Detroit, MI)
- …**Essential Functions and Responsibilities as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...support the level of care being billed . Conducts concurrent reviews to ensure criteria for patient status and… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization ... commercial and government payers. This individual is responsible for concurrent and continued stay Utilization Management...+ Required: + Currently licensed as a Registered Professional Nurse in New York State. + Associates Degree +… more
- CVS Health (Helena, MT)
- …**Preferred Qualifications** + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent review or prior ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- Independent Health (Buffalo, NY)
- …and Accountable. **Essential Accountabilities** + Provide high quality, professional utilization management services: (medical necessity review for Prior ... benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to...review.) + Prompt, courteous, and error free in performing utilization management functions. + Available to answer… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Actalent (Rancho Cordova, CA)
- …and completion of the file Skills: Utilization review, Case management , Acute care, Prior authorization, Interqual, Concurrent review, Discharge planning, ... Five or more year's clinical experience required. Three to five years Utilization Management experience required. One to three years charge/lead/supervisory/… more
- Ascension Health (Birmingham, AL)
- …Birmingham, AL (remote) At least 3 years of acute care experience and utilization management experience **Benefits** Paid time off (PTO) Various health insurance ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** Full Time, 40 hours weekly, Monday - Friday 7:30am - 4pm + **Hospital:** Ascension Via ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- UNC Health Care (Rocky Mount, NC)
- …hospital, continued stay, and use of other hospital services in accordance with Utilization Management Plan, Conditions of participation (CoP) and other federal ... (physicians, other health care professionals, payers, etc.) to identify appropriate utilization of hospital resources and to ensure timely reimbursement for services… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited...Degree in a health related field. + 3 Years Utilization Management or case management … more
- Centene Corporation (Atlanta, GA)
- …adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management… more
- WellSpan Health (York, PA)
- … principles throughout the System. Duties and Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials ... 5 years In leadership experience. Required + 3 years Utilization Management Experience. Preferred Licenses: + Licensed Registered Nurse Preferred Knowledge,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral ... level of care setting for continued treatment. Employs the utilization management process to assist in setting...regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
