- University Medical Center of El Paso (El Paso, TX)
- …Experience: Work Experience: Two years of experience with clinical documentation, chart reviewing, utilization review , managed care , and/or claims ... denials and appeals processing required. License/Registration/Certification: Certified Clinical Documentation Specialist preferred. Education and Training: Bachelor's degree in related field required. more
- The University of Vermont Health Network (Colchester, VT)
- …workforce.PRIOR EXPERIENCE3-5 years acute care hospital nurse and/or3-5 years chart review , prior authorizations, managed care , familiarity of clinical ... POSITION SUMMARYThe Utilization Review Nurse is responsible for...guidance and criteria as well as those of various managed care insurance plans.MINIMUM REQUIREMENTSState of Vermont… more
- The University of Vermont Health Network (Plattsburgh, NY)
- …Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and ... based on benchmarked criteria or established practices. The Utilization Review RN in utilizing these skills...and The Joint Commission regulations is preferred.10. Knowledgeable in managed care processes is preferred. Computer experience… more
- Rio Vista Behavioral Health (El Paso, TX)
- …managed care pre-certification process, level of care assessments and utilization preferred.LICENSES/DESIGNATIONS/CERTIFICATIONS:Current licensure, as ... professional responsible for facilitating admissions, clinical intake assessments and utilization review processes to assure continuity for the… more
- RestoraCare Staffing (Houston, TX)
- …management, case management, performance improvement, disease or population management and managed care reimbursement. Understanding of pre-acute and post-acute ... nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes Utilization Management and Quality… more
- Universal Health Services (Colorado Springs, CO)
- …an accredited college or university with a current Colorado RN license. Experience in utilization review , managed care , or determining appropriateness ... position is responsible for providing initial, ongoing, and systematic utilization review on all patients assigned by...with work hours to accommodate work volumes. Knowledge of utilization management and managed care … more
- CVS Health (Columbus, OH)
- …IT platforms/systemPreferred Qualifications - Knowledge of Medicare/Medicaid - Utilization Review experience preferred - Managed care experience - ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...in state of residence - Must have previous inpatient utilization review experience - Must be able… more
- Catholic Health (Lockport, NY)
- …+ Two years medical surgical nursing and/or job related experience + Preferred prior insurance / managed care / utilization review experience in the role of ... and Holiday Rotation Hours: 8:00a-4:00p, 9:00a-5:00p, 10:00a-6:00p, 11:00a-7:00p Summary: The RN Care Manager, Utilization Review / Transitions of Care… more
- CVS Health (Raleigh, NC)
- …(PowerPoint, Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... ability to innovate and deliver solutions to make health care more personal, convenient and affordable. This Utilization... care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote… more
- CVS Health (Columbus, OH)
- …1 holiday per year). Preferred Qualifications: - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - Strong ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- CVS Health (Harrisburg, PA)
- …- Holiday rotation required Preferred Qualifications: - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - Strong ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- CVS Health (Harrisburg, PA)
- …(PowerPoint, Word, Excel, Outlook) Preferred Qualifications: - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- Lancaster General Health (Lancaster, PA)
- …Board of Nursing. + Bachelor's degree in Nursing (BSN). + Knowledge of utilization review or managed care . + Care management experience in a ... care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources. + Oversees and guides the… more
- CVS Health (Frankfort, KY)
- …outside of the standard schedule based on business needs Preferred Qualifications: + Managed care / utilization review experience preferred + Experience ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- Trinity Health (Farmington Hills, MI)
- …years of nursing experience, to include two (2) years of utilization review /case management, managed care or comparable patient payment processing ... rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands … more
- Kelsey-Seybold Clinic (Pearland, TX)
- …2 years in area of specialization, 2 years of Case Management/ Utilization Review experience **Other** Required: Managed Care knowledge Preferred: N/A ... and various internal departments **Job Title: Case Manager Concurrent Review ** **Location: Pearland Administrative Office** **Department:** **KCA Utilization … more
- St. Luke's University Health Network (Lehighton, PA)
- …health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. Please ... mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care… more
- St. Luke's University Health Network (Phillipsburg, NJ)
- …health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. WORK ... mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care… more
- CVS Health (Salt Lake City, UT)
- …setting such as ambulatory care or outpatient program- Managed care and utilization review experience preferred.- Crisis intervention skills ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- Trinity Health (Farmington Hills, MI)
- …office staff, Patient Access, Medical Records/Health Information Management, Utilization Review /Case Management, Managed Care , Ancillary and Nursing ... Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required.… more
