- GHR Healthcare (Atlanta, GA)
- …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 based on ... and act as a resource for members navigating the healthcare system. Data Management: Maintain accurate records and report trends or issues to improve care quality . more
- US Tech Solutions, Inc. (Columbia, SC)
- …PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that is not very common. ... a typical day would like in this role: The nurse would work remotely from their home reviewing authorization...any of the following in support of medical claims review and utilization review practices:… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the health ... Colorectal, Minimally Invasive GYN and Minimally Invasive Surgery. Job SummaryThe Nurse Manager (NM) functions as the first-line administrative nursing leader, with… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …team members as needed to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure ... 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… more
- Engage Partners, Inc. (Orange, CA)
- …competent services. Ensure charts meet quality management standards per monthly utilization review and/or chart review process, including completion of ... The Nurse Supervisor supervises and manages nursing staff to ensure provision of quality client care and effective team performance to meet agency goals in… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …at all campuses operated by NGHS. Collaborates with the physicians, patients, families, nursing, utilization review and other members of the health care team to ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted...effectively aligns with patient needs using resources to meet quality , clinical, and cost-effective outcomes. Coordinates a team approach… more
- Blanchard Valley Health System (Findlay, OH)
- …Care Transitions Team, including the disciplines of Social Work, Case Management, Utilization Review , and Emergency Department Care Navigation to support ... of appropriate services during acute care stay. Duty 9: Maintains position as Utilization Review committee chair. Works in collaboration with ambulatory care… more
- Ascension (Hanover, MD)
- …including but not limited to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment ... length of stay.Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …therapy skills Essential Tasks and ResponsibilitiesWorks with the Clinical Coordinator and Nurse Manager to develop patient schedules for inpatient, DPH and IOP ... help management determine long term focus.Meets routinely with Clinical Coordinator, Nurse Manager, House Coordinators, Medical Director and Manager of Clinical… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …of our communities. About the Role:Job SummaryResponsible for the systematic review of patient throughput including evaluating and implementing strategies and ... direction. Provides nursing involvement support for VOICE and the NDNQI quality teams including providing team members for professional participation. Assists with… 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
- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Nurse ** **Location: Hospital Client ... vary and some flexibility may be offered** As our ** Utilization Review Nurse ** , you...to ensure accurate clinical data. + Adhere to established quality , timeliness, and productivity outputs required in the completion… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …of communication with clinic, payor and other customers. **Job Title: Licensed Vocational Nurse Utilization Review -** ** Utilization Management--Sign on ... **Responsibilities** The Utilization Review LVN nurse ...as we continue to grow, our focus is providing quality patient care by adding to our team of… more
- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to determine ... Accountable. **Essential Accountabilities** + Provide high quality , professional utilization management services: (medical necessity review for Prior… 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
- 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... and to support the safety net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the… 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 ... Management/Social Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health ... more at UCLA Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and… more
