- 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
- 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 (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
- 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 (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
- CVS Health (Springfield, IL)
- …in time zone of residence Preferred Qualifications - Utilization Management review - Managed Care experience- Client processing experience Education ... 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 (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
- Martin's Point Health Care (Portland, ME)
- …years clinical nursing experience + Utilization management experience in a managed care or hospital environment required + Certification in managed ... has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring… more
- Providence (Napa, CA)
- … management experience in the acute, sub-acute, home health setting or managed care environment. **Preferred qualifications:** + Bachelor's Degree in Nursing. ... . The RN Case Manager assists patients in the utilization of appropriate health care services. Position...time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas… more
- Sharp HealthCare (San Diego, CA)
- …SNF setting. + 2 Years Utilization /Case Management experience, preferably in a Managed Care setting. + California Licensed Vocational Nurse (LVN) - CA Board ... of care for SRS Members. Ensure timely and appropriate processing of managed care referrals to meet specific healthcare criteria in a cost-effective manner… more
- Billings Clinic (Billings, MT)
- …to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN CARE ... Rule, or payer authorization for status and level of care *Priority 2: Performs Utilization Review...At hire * Current working knowledge of payer and managed care reimbursement preferred. * Working knowledge… more
- Sutter Health (Berkeley, CA)
- …clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively ... length of stay as received from managed care or third party payors. Appeal adverse review...nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with… more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse III - Hospital Case Management/ Utilization Review Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4396275) Apply ... Per Diem Registered Nurse III - Hospital Case Management/ Utilization Review Salary $119,061.54 - $151,803.47 Annually...Centers for Medicare & Medicaid Services (CMS), Department of Managed Health Care (DMHC), National Committee for… more
- Universal Health Services (Doylestown, PA)
- Responsibilities Foundations Behavioral Health is currently hiring a full-time Utilization Review Coordinator to support our UM Department in Doylestown, PA. ... including peer reviews and appeals, in accordance with the Utilization Review Plan, for patient population ages...UM Coordinator will interface with licensing and accrediting agencies, managed care companies, family members, and healthcare… more
- Tenet Healthcare (Detroit, MI)
- …Denial and Revenue Cycle Collaborate with Patient Access, Case Management, Managed Care and Business Office to improve concurrent review process to avoid ... RN Utilization Review FT Days - 2305004256...RN Utilization Review FT Days - 2305004256 Description : The... care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more