- The County of Los Angeles (Los Angeles, CA)
- …supervisors, the activities of the Utilization Review Nurses engaged in utilization review activities, in accordance with the Professional Standards Review ... the last five (5) years in the supervision* of nursing staff engaged in utilization review activities. -AND- 2 . Current certification issued by the American… more
- Children's Mercy Kansas City (Kansas City, MO)
- …in compliance with regulatory and organizational standards. + Develops professional expertise and leadership of the Admission and Denials Care Managers, ... and regulatory activities that impact reimbursement for clinical services and professional activities. + Demonstrates prudent resource utilization . + Educates… more
- Sharp HealthCare (San Diego, CA)
- …by the collective bargaining agreement between Sharp HealthCare and Sharp Professional Nurses Network, United Nurses Associations of California/Union of Health Care ... the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center (CPPC)… more
- Centene Corporation (Austin, TX)
- …(UM) to align to goals and objectives + Develops, implements, and maintains compliance with utilization management policies and procedures + Reviews ... of Nursing or Bachelor's degree and 5+ years of related experience. 2 + years supervisory experience preferred. Knowledge of utilization management principles… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …and maintains records as required; collects, analyzes and reports on data for utilization , quality improvement, compliance , and other areas as assigned. PATIENT ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness… more
- Universal Health Services (Riverside, CA)
- … of services within the Utilization management Department. Prepare useful utilization statistics from this data. 2 . Prepare monthly reports and analyze ... a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives...utilization data (ie percentage of C-sections, mental health utilization , home health/ DME utilization , and number… more
- LA Care Health Plan (Los Angeles, CA)
- …5 years of varied clinical experience in an acute hospital setting. At least 2 years Utilization Management/Case Management experience in a hospital or HMO ... Utilization Management Nurse Specialist RN II Job Category:...nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make… more
- Catholic Health Initiatives (Omaha, NE)
- …and post discharge for appropriate status determination. 2 . Ensures compliance with principles of utilization review, hospital policies and external ... thinking and problem-solving skills. Collaborate effectively with multiple stakeholders Professional communication skills. Understand how utilization management… more
- University of Colorado (Aurora, CO)
- Clinical Utilization Review Specialist - 32339 University Staff **Description** **University of Colorado Anschutz Medical Campus** **School of Medicine | Department ... of Psychiatry** **Job Title: Clinical Utilization Review Specialist** **Position: #00217340 - Requisition: #32339** **Sign-on...Medicaid. + Perform other concurrent and retrospective reviews with 2 -4 business days or earlier as directed by Program… more
- Elevance Health (Miami, FL)
- …and standards. **Minimum Requirements:** + Requires a LPN, LVN, or RN and minimum of 2 years of clinical or utilization review experience and minimum of 2 ... **Licensed Utilization Review Senior** _Location:_ While remote, candidate should...by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members… more
- Corewell Health (Caledonia, MI)
- …providers to provider relations or management staff. Assures clinical staff compliance with credentialing requirements, and monitors utilization and referral ... Together, we are Corewell Health. Scope of Work Supervises assigned Utilization Management staff. Plans, organizes, and supervises all assigned clinical and… more
- University of Virginia (Charlottesville, VA)
- Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management process. They collaborate with physicians and ... members of the healthcare team to promote and adhere to regulatory compliance . The UM RN conducts initial concurrent and retrospective medical necessity reviews.… more
- University of Virginia (Charlottesville, VA)
- Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management process. They ... members of the healthcare team to promote and adhere to regulatory compliance . The UM RN conducts initial concurrent and retrospective medical necessity reviews.… more
- Sharp HealthCare (San Diego, CA)
- …specific while determining medical necessity and appropriateness. **Required Qualifications** + 2 Years Experience in a medical setting (ie office, hospital, SNF, ... and refer members to case management or quality management as appropriate for utilization or quality issues while maintaining department processes in compliance … more
- Sharp HealthCare (San Diego, CA)
- …Responsible for UM adverse determination letters to include ensuring compliance with appropriate reading level and regulatory agency requirements. Performs ... specific while determining medical necessity and appropriateness. **Required Qualifications** + 2 Years relevant experience in a medical setting (ie: office,… more
- Caterpillar, Inc. (East Peoria, IL)
- …building a better world, so we can all enjoy living in it. **Risk & Compliance Professional ** **Your Impact Shapes the World at Caterpillar Inc.** When you join ... **Career Area:** Legal and Compliance **Job Description:** **Your Work Shapes the World...to plan, organize, monitor, and control projects, ensuring efficient utilization of technical and administrative resources to achieve project… more
- Rush University Medical Center (Chicago, IL)
- …compliance with treatment plan **Leadership** 1.Demonstrates accountability for professional practice, continuing education and progress toward achievement of ... AM - 5:30:00 AM) **Summary:** The Oncology Nurse Navigator 2 is a registered nurse (RN) who works with...physician practices and multi-disciplinary teams to promote the effective utilization of services and coordination of care for patients… more
- New York State Civil Service (Albany, NY)
- …of Title Compliance Specialist 1 (VID 157171) Occupational Category Other Professional Careers Salary Grade 18 Bargaining Unit PS&T - Professional , ... Goal Waiver requests.* Perform research, analysis, documentation as assigned by the Compliance Specialist 2 .* Generate outreach campaigns to inform MWBEs and… more
- Publicis Groupe (Atlanta, GA)
- … compliance is adding value; identify and pursue opportunities to optimize compliance coverage and resource utilization Qualifications What we look for: + ... Bachelor's degree or commensurate related work experience + 2 + years experience delivering high-quality professional services to business clients + Proficiency… more
- Providence (Mission Hills, CA)
- …in a healthcare organization working with health plan or government regulations. + 2 years' Audit and compliance experience. + Recent experience working with ... **Job Schedule:** Full time **Job Shift:** Day **Career Track:** Business Professional **Department:** 7520 CLAIMS COMPLIANCE CA HERITAGE SERVICES **Address:**… more