- University of Miami (Miami, FL)
- …. The University of Miami is currently seeking Utilization Review Case Manager to ... reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates...They are accountable for a designated patient caseload and provide intervention and coordination to decrease avoidable delays, at… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....background check, drug screen, physical and be able to provide positive employment references. + Physical Demands: With or… more
- Trinity Health (Fresno, CA)
- …responsible for management, leadership, and coordination of the departments of the Utilization Manager Team to ensure payor reimbursement for services rendered ... the healing mission of Saint Agnes Medical Center. The Manager Utilization Management will ensure the timely...Utilization Management will ensure the timely delivery of utilization review , discharge planning and support case… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Manager of Utilization Review will provide leadership to integrated inpatient teams and assist ... InterQual and/or MCG screening guidelines, and oversight of clinical denials/appeals. The Manager of Utilization Review participates in department and… more
- Elevance Health (Winston Salem, NC)
- …send you a check, or ask you for payment as part of consideration for employment. ** Manager I, Utilization Review Management** + Job Family: CUS > Service ... Date:May 03, 2024 + Reference: JR109280 **Location:** + NC, WINSTON **Description** ** Manager I, Utilization Review Management** **Location: Candidates must… more
- Providence (Missoula, MT)
- **Description** **Care Manager RN in Utilization Review Unit at Providence St. Patrick Hospital Missoula, MT** The Nurse Case Manager (NCM) is ... Schedule:** Part time **Job Shift:** Variable **Career Track:** Nursing **Department:** 3500 UTILIZATION REVIEW **Address:** MT Missoula 500 W Broadway **Work… more
- Actalent (Oklahoma City, OK)
- …license required. * Case Manager , Discharge Planner, UR experience. * Utilization review experience in a facility Experience Level: Intermediate Level About ... Description: Utilization Review Nurse perform integrated case...necessity and contractual benefits. * Provides guidance to the provider network via telephone triage. * Performs effective discharge… more
- Ascension Health (Indianapolis, IN)
- …with your Talent Advisor for additional specifics._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... implement quality review programs and key performance indicators for all utilization review activities. + Interact with medical, nursing, and executive… more
- Public Consulting Group (Council Bluffs, IA)
- …and/or healthcare and fraud investigations. + 2-5 years of experience as a utilization review manager conducting, directing, or leading medical necessity ... review activities. + Knowledge of claims and medical record review data across provider service types. + Ability to delegate and manage caseload across… more
- Providence (Napa, CA)
- …Schedule:** Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work ... families throughout the continuum of care. The RN Case Manager assists patients in the utilization of...career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace… more
- LA Care Health Plan (Los Angeles, CA)
- …Practitioner (NP)- Active, current and unrestricted California License Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) ... Manager , Delegation Oversight Clinical Audit Job Category: Clinical...oversight and adequate performance of delegated activities. Collaborates with Utilization Management (UM), Provider Network Operations and… more
- Providence (Medford, OR)
- …and geriatric, based on population focus. Duties also include complex discharge planning and utilization review . The Nurse Case Manager must be competent to ... **Description** The RN Case Manager is an expert professional registered nurse who...year home health, mental health, substance use, hospice, and/or utilization review + Progressive nursing leadership experience,… more
- LA Care Health Plan (Los Angeles, CA)
- …current and unrestricted California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager ... Manager , Enhanced Care Management (RN or LCSW) Job...public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN CARE MANAGEMENT ... loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This position is...*Priority 5: Escalation *Refers cases that require second level review to Physician Advisor, Manager , and Director… 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
- Catholic Health Initiatives (Omaha, NE)
- …Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. **Preferred** Certified Case Manager (CCM), Accredited Case ... **Overview** Utilization Review RN is responsible for...denials prevention. 9. Coordinates Peer to Peer between hospital provider and insurance provider , when appropriate. 10.… more
- LA Care Health Plan (Los Angeles, CA)
- …current and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- Munson Healthcare (Traverse City, MI)
- …possess the strong clinical assessment and critical thinking skills necessary to provide utilization review responsibilities. Superior organization and time ... status and progression of care. + Consults with case manager and/or physician advisor as necessary to resolve progression-of-care...payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? +… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- Eglin AFB, FL, USA | Full Time Registered Nurse - Utilization Manager Onsite Position EM Key Solutions is seeking Registered Nurse (RN) for a full-time ... Utilization Review / Management position supporting the...active duty, reserve/guard admissions to civilian hospitals and notifies Utilization Manager and Patient Administration Element as… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- Eglin AFB, FL, USA | Hourly | Full Time Registered Nurse - Utilization Manager Location: Eglin Hospital at Eglin AFB, Fort Walton Beach, FL. Position Type- ... is seeking a Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the...duty and reserve/guard admissions to civilian hospitals and notifies Utilization Manager and Patient Administration Element as… more