- AmeriHealth Caritas Health Plan (Washington, DC)
- Role Overview Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... to efficiently document and assess patient cases Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- US Tech Solutions (Canton, MA)
- …This is Fully remote, but Massachusetts RN license required. Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... for managing a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical… more
- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …and facilitate repatriation efforts. Provides guidance to UM Coordinators on complex outpatient TARs that require clinical judgment and application of medical ... $128752.00 - $165048.00 Salary Description SUMMARY OF POSITION: The Utilization Management (UM) Nurse is a licensed nursing professional...MSO UM team, MSO Medical Director, and MSO Physician Reviewer on UM case reviews. The UM Nurse will… more
- Cottage Health (Goleta, CA)
- Job Description Cottage Health seeks a Utilization Review Manager, Registered Nurse for their Clinical Denials and Appeals department responsible for the ... overall management of utilization review processes and clinical ...is also responsible for processes associated with patient status (inpatient/ outpatient ) within Cottage Health. This individual serves as a… more
- EvergreenHealth (Kirkland, WA)
- …provides intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support, and training of team ... arrange for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our… more
- UHS (Temecula, CA)
- …Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time RN Central Utilization Review Nurse who will be responsible for carrying out ... ensure correct payer source for hospitalization and communication. Ensures compliance of utilization review practices as required by payers, external regulatory… more
- Optum (Portland, ME)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... etc.; serves as an educational resource to all Health System staff regarding utilization review Assumes roles in assessment physical, psychosocial, & economic… more
- Veterans Health Administration (Phoenix, AZ)
- …Duties include but not limited to: Patient Aligned Care Team (PACT) Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based ... education, orientation, competencies and providing quality improvement and outcomes utilization . Demonstrates leadership in delivering and improving holistic, primary… more
- Kaiser Permanente (Lancaster, CA)
- …education requirements for licensure. License, Certification, Registration Controlled Substance Utilization Review and Evaluation System Registration required at ... Description: Job Summary: Under indirect supervision, provides patient care, clinical activities, and patient consultations within the scope of pharmacy practice… more
- New Oakland Family Centers (Warren, MI)
- …Maintain consistent communication with clinical and administrative staff. Complete Utilization Review assignments including but not limited to obtaining ... ages and families across the state of Michigan in outpatient , partial hospital and crisis care settings. The mission...equivalent as determined by Director or Supervisor Reports to: Clinical Director / Associate Clinical Director /… more
- Healthcare Staffing Plus (Boston, MA)
- … clinical nursing issues and conduct quality improvement research utilization projects. Ability to effectively delegate appropriate patient care activities. ... families across the health care continuum. The registered nurse is accountable for clinical , educational, quality and fiscal patient care outcomes using the model of… more
- Regional One Health (Memphis, TN)
- …strength, frequency and method of administration. *Consults on drug therapy, drug regimen review and drug utilization review . *Consults on drug storage ... statement and determination of important aspects of care for clinical review . *Assists in the development of...*Assists in care and maintenance of equipment and effective utilization of supplies. *Cleans and maintains all pharmacy related… more
- Vinfen (Lowell, MA)
- …Clinical Supervisor will also: Participate in regular Quality Improvement and Utilization Review activities consistent with the Behavioral Health Division's ... LMHC credentials valid in Massachusetts. Minimum of four years of clinical experience in an outpatient or similar behavioral health setting; a minimum of 2 years… more
- HCA Healthcare (Houston, TX)
- Introduction Do you have the career opportunities as a Clinical Director of Nursing that you want with your current employer? We have an exciting opportunity for you ... to join Gramercy Outpatient Surgery Center which is part of the nation's...of colleagues. Do you want to work as a(an) Clinical Director of Nursing - Surgery Center where your… more
- Veterans Health Administration (Austin, TX)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic [appointment availability] ( utilization ) to ensure that clinic ... position is to serve as an AMSA assigned to outpatient clinics. The AMSA position is a fundamental role...and revenue collection. Incumbent promotes Veteran registration for and utilization of My HealtheVet (MHV), an online personal health… more
- WellSpan Health (Ephrata, PA)
- …planning and implementation of patient care based upon sound nursing judgment, clinical preparation, knowledge, skills and experience. Nursing care is provided in ... Board of Nursing. In addition, serves as a nursing resource for clinical staff. Responsibilities Duties and Responsibilities Remote Work Capable Essential Functions:… more
- Casa Esperanza (Boston, MA)
- …integrated care. Join Casa Esperanza - Make a Difference Every Day Position: Clinical Supervisor ( Outpatient Services) On-Site | Boston, MA Full-Time (40 ... up to $7.5K in Relocation Assistance Reimbursement About the role: We're seeking a Clinical Supervisor to join our dedicated Outpatient Services team. In this… more
- Healogics (Livingston, TX)
- …and working on patient care quality improvement. The CPD partners with the for review of clinical practice. As needed, serves as case manager to a ... many patients that would benefit through our out-patient clinic partnerships The Clinical Program Director is responsible for the management and the strategic growth… more
- Iconma LLC (Detroit, MI)
- …which may include acute patient care, discharge planning, case management, and utilization review , etc. Demonstrated clinical knowledge and experience ... Detroit, MI/Hybrid location. Responsibilities: Perform prospective, concurrent and retrospective review of inpatient, outpatient , ambulatory and ancillary… more
- Veterans Health Administration (Johnson City, TN)
- …care team, or other specialty care. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... Collect, scans, and updates health insurance information, promote Veteran registration and utilization of My Healthy Vet (MHV). Train other MSAs on correct clinic… more
