- Spectraforce Technologies (Columbia, SC)
- …Responsibilities: 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews ... Summary: Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility… more
- Universal Health Services (Temecula, CA)
- …Summary: The Southwest Healthcare Regional office in Temecula, CA is seeking Two (2) LVN Full-Time Central Utilization Review Nurses who will be responsible ... correct payer source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers, external regulatory… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical records ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** **Shift ... necessity reviews and authorizes medical services that meet medical criteria. The review of care is region specific and consists of outpatient healthcare services… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** **Shift ... UM Department. Prepares referral requests for outpatient services, elective inpatient admissions, skilled nursing facility admissions, durable medical equipment… more
- Molina Healthcare (Bronx, NY)
- …are eligible for Medicaid and Medicare.** **We are looking for a LPN or LVN Care Review Clinician with Prior Authorization experience. Experience with ... (UM) is highly preferred. Additional experience with appeals, quality review , MLTC/LTC experience, and experience with data collection/reports.** **_Bilingual… more
- Universal Health Services (Palmdale, CA)
- …patient and his family. This person is the expert on issues related to utilization review and discharge planning. Qualifications Requirements: + Ability to read, ... clinical experience and minimum of three years C linical C ase Management/ Utilization Review experience (preferred). Motivation for self-direction. + Minimum of… more
- The Arora Group (Bethesda, MD)
- …- Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/ LVN ) - Utilization Review in Bethesda, Maryland to provide care to ... on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/ LVN ) - UTILIZATION REVIEW : +...team (ie financial billers). + The Contractor shall provide utilization reviews for both inpatient and outpatients… more
- Elevance Health (Miami, FL)
- **Licensed Utilization Review Senior** _Location:_ While remote, candidate should reside within 50 miles of either Tampa or Miami, FL. The **Licensed ... Utilization Review Senior** is responsible for working... management function. Examples of such functions may include: review of claim edits, pre-noted inpatient admissions… more
- Banner Health (Mesa, AZ)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... individual and support the family through their grieving process. Inpatient Home care is also available for respite care...MINIMUM QUALIFICATIONS Must possess a current, valid LPN or LVN license in state of practice, temporary LPN or… more
- Banner Health (Tucson, AZ)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... an operating agreement with Pima County. Our specialty services include inpatient and outpatient behavioral health, treatment and education for diabetes, innovative… more
- Molina Healthcare (San Antonio, TX)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient /outpatient medical ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- Universal Health Services (Kingwood, TX)
- …for a virtual Facility Tour (https://kingwoodpines.com/about-us/our-campus/) Position Summary The Utilization Review (UR) Coordinator will perform admission and ... or a Nursing degree preferred. Knowledge of behavioral health systems and Utilization Management required. + Minimum of two (2) years professional experience in… more
- Fresenius Medical Center (Garden City, NY)
- **PURPOSE AND SCOPE:** The professional registered nurse Inpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... appropriate tasks to direct patient care staff including but not limited to RNs, LVN /LPNs and Patient Care Technicians. As a member of the kidney disease health care… more
