- RestoraCare Staffing (Houston, TX)
- …Health Clinic (FQHC), skilled nursing facility, or wound clinic). Experience in utilization management , case management , discharge planning or other ... RestoraCare Staffing is seeking a Registered Nurse (RN) Case Management for a...and PC skills Current working knowledge of discharge planning, utilization management , case management , performance… more
- Kepro (Indianapolis, IN)
- …vital partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our ... growing team. Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management / Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II… more
- Centene Corporation (Sacramento, CA)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (Hartford, CT)
- …RN licensure in state of residence Preferred Qualifications Managed Care experience Utilization Management experience Appeals experience Pre Certification ... hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare… more
- The Cigna Group (Nashville, TN)
- …**Job Requirements include, but not limited to:** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C ... **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We...services as well as Part B drugs. The Case Management Analyst will be responsible for analyzing and responding… more
- Trinity Health (Farmington Hills, MI)
- …regulations, healthcare financing and managed care. Knowledge of and experience in case management and utilization management . Knowledge of insurance and ... rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review/Case Management departments; + Reviews and understands … more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Resource Management issues, other issues including concerns involving under/over utilization , avoidable days and quality issues. 13. Responsible for all incoming… more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/ Utilization Management /Quality. Strong verbal and written ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category:...a lead/supervisory experience. Equivalency: Completion of the LA Care Management Certificate Training Program may substitute for the supervisory/… more
- Penn Medicine (Philadelphia, PA)
- … appeals correspondence. + Maintains database for the department and the utilization management requirements for the hospital information system and within ... Clinical Appeals Coordinator in all phases of the Clinical Quality and Utilization Management functions including but not limited to data entry, obtaining… more
- Trinity Health (Farmington Hills, MI)
- …in the timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management /Coding/ Nurse Liaison to provide required ... as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves… more
- ERP International (Tinker AFB, OK)
- …and Tasks: Duties may include but are not limited to** : Provides Utilization Management activities and functions by using MTF-specific Quality Improvement ... **Overview** ERP International, LLC is seeking a **Registered Nurse - Utilization Managment** for a...and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/Hybrid (2 ... correct status for patients, denial management , appeal rights/ appeals and utilization management competencies...of nursing. 2. Current registration as a Registered Professional Nurse in New York State. 3. Bachelor of Science… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …EM Key Solutions is seeking Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the Medical Maintenance Team at Eglin ... Eglin AFB, FL, USA | Full Time Registered Nurse - Utilization Manager Onsite Position...to the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …EM Key Solutions is seeking a Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the Medical Maintenance Team at Eglin ... AFB, FL, USA | Hourly | Full Time Registered Nurse - Utilization Manager Location: Eglin Hospital...to, the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the… more
- Beth Israel Lahey Health (Burlington, MA)
- …Functions and Responsibilities:** Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that ... payer certification, and denied cases. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… 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 ... UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission… more
- Adecco US, Inc. (Dallas, TX)
- **Join Our Team as a Utilization Management Nurse !** **Experience Required:** + Five years inpatient clinical nursing experience in an acute care hospital ... setting + Minimum of two years Utilization Management acute care setting experience +...Minimum of one year drafting and submitting reconsiderations and appeals to Medicare + Preferably a minimum of two-year… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
