- Carle Health (Champaign, IL)
- …patient care outcomes. The incumbent will have a deep understanding of utilization review and case management principles, case management best practices, ... experience - External Applicants Only Hybrid Option The Registered Nurse (RN) who serves in the role of System...years Responsibilities Maintain current knowledge of case management and utilization review trends including the entire continuum… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point ... this position is able to cover a multitude of utilization review functions through point of entry,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse… more
- Corewell Health (Caledonia, MI)
- …continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides ... financial and utilization management (UM) information to other members of the...multiple clinical settings, or related experience Required + Registered Nurse (RN) - State of Michigan required How Corewell… more
- CareFirst (Baltimore, MD)
- …Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent ... and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical information,… more
- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + ... Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Immigration and Customs Enforcement (Washington, DC)
- …with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist , Medical Asset Support Team (MAST) member works under ... clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... the key performance indicators and quality measures, the RN specialist also aims to foster a culture of safety...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review … more
- UPMC (Harrisburg, PA)
- …the most specialized and rewarding areas of pediatric medicine. Purpose: The Programmatic Nurse Specialist , a professional registered nurse , has the ... the nursing process. In collaboration with the health care team, the Programmatic Nurse Specialist applies expert clinical knowledge and skills to achieve… more
- Ascension Health (Austin, TX)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days **Department** : CSRC CDI Services… more
- PeaceHealth (Bellingham, WA)
- …+ Preferred: Third party reimbursement knowledge. + Preferred: Utilization Review experience. **Credentials** + Required: Registered Nurse in state of ... **Description** PeaceHealth is seeking a RN Admissions/ Utilization Behavioral Health - Care Management for a...practice + Preferred: Psychiatric/Mental Health Clinical Nurse Specialist **Skills** + Strong psychiatric nursing… more
- Tufts Medicine (Melrose, MA)
- …role is essential in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with ... managers, TMIN Practice Optimization Coaches (POMs) and primary care providers to review patient records, analyze data, and identify practice and patient outlier … more
- Hospice of Michigan (Southfield, MI)
- …work with minimal supervision. + Requires knowledge of quality assessment and utilization review functions, principles and practices. + Theoretical and practical ... personnel on the QAPI plan, and team development. + Performs clinical record review activities for data collection. + Compiles, analyzes, trends and reports quality… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Trinity Health (Syracuse, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse , physicians, staff and ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified… more
- HCA Healthcare (Dallas, TX)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... commitments to referral sources. Develops a call-plan to prioritize utilization of time. + Assists in developing the annual...we encourage you to apply for our Clinical Rehab Specialist opening. We promptly review all applications.… more
- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
