- UHS (Palmdale, CA)
- …Minimum of 5+ years strongly preferred. Certifications/Licenses: Current license as a Registered Nurse in the State of California required. Current ... . Job Summary: Southwest Healthcare is seeking a Full-Time Remote RN Clinical Documentation Integrity Specialist . Duties include but not… more
- Denver Health (Denver, CO)
- …insurance plan required . Previous grievance and appeals experience preferred. Licenses : RN - Registered Nurse - DORA - Department of Regulatory Agencies ... We are recruiting for a motivated RN Health Plan Grievance & Appeals Specialist...a Colorado Resident Job Summary Under minimal supervision, the Registered Nurse , Grievance & Appeals is responsible… more
- Guardian Life Insurance Company (Bethlehem, PA)
- As the Clinical Specialist LPN/ RN , Disability Claims you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to… more
- Conifer Health Solutions (Sherwood, AR)
- …from a Nursing program, BSN, or graduate CERTIFICATES, LICENSES, REGISTRATIONS Active state Registered Nurse license Preferred: CDIP or CCDS PHYSICAL DEMANDS The ... DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Record Review : Completes initial medical records reviews of patient records within 24-48… more
- Cedars Sinai (Los Angeles, CA)
- …experience required 3 years of previous experience in case management, discharge planning, utilization review , and HMO in the acute inpatient or outpatient ... their needs, coordinating care, communicating with health plans (including concurrent review , which assists the hospitalist/ specialist and case manager to… more
- Baptist Health (Alabaster, AL)
- …as an advocate for patient's health care needs. *Performs admission and concurrent utilization review in compliance with review requirements for Managed ... contracts, governmental payors (ie Medicare, Medicaid, and Champus) and departmental review policies; adheres to Utilization Management Plan. *Communicates in… more
- HCA Healthcare (San Antonio, TX)
- …Supervisory experience preferred Certifications, Licenses, and other Special Requirements Current/Active Registered Nurse ( RN ) License within practice state ... regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records...we encourage you to apply for our Clinical Manager RN opening. We promptly review all applications.… more
- Roper St Francis Healthcare (Summerville, SC)
- …for Primary Charge Nurse I. Experience: At least 2 years' experience as a registered nurse in a direct care patient setting for Primary Charge Nurse ... role. Licensure/Certification: Applicant must be currently licensed as a Registered Nurse in South Carolina or hold...to run effective shift safety huddles, report safety concerns, review device utilization , report staffing concerns, and… more
- Roper St Francis Healthcare (Charleston, SC)
- …for Primary Charge Nurse I. Experience: At least 2 years experience as a registered nurse in a direct care patient setting for Primary Charge Nurse ... role. Licensure/Certification: Applicant must be currently licensed as a Registered Nurse in South Carolina or hold...to run effective shift safety huddles, report safety concerns, review device utilization , report staffing concerns, and… more
- THE INSTITUTE FOR FAMILY HEALTH (New York, NY)
- …Must have at least one of the listed licensures/certifications: Current NY State Registered Nurse ( RN ) or Certified Dietitian/Nutritionist (CDN) or Current ... Health Care Description SUMMARY: The Certified Diabetes Care and Education Specialist , in collaboration with the multidisciplinary team and in accordance with… more
- CAMC Health System (Weston, WV)
- …experience. Education *Associate's Degree (Required) *Bachelor's Degree Credentials * Registered Nurse (Required) Work Schedule: Varies Status: ... Job Summary Under the direction of the Nurse Director, the Nurse Manager is...implements programs and services. Conducts daily environment of care review to ensure compliance with regulatory standards, federal, state… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- HonorHealth (AZ)
- …different here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required more
- Nuvance Health (Danbury, CT)
- …other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required : ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the...CT Registered Nurse License Working Conditions: Manual: significant… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact ... Review experience.** Medical Coding experience is a plus! As our Utilization Review RN , you will be responsible for conducting comprehensive reviews of… more
- Amergis (Rancho Cordova, CA)
- …Utilization Management. Apply today to learn more about the current opportunities! The Utilization Review Specialist is responsible for theassessment and ... + Current license for the state in which the nurse practicesif nursing licensure is required by contract +...Degree in Nursing or at least two years'experience in Utilization Review preferred + Certification in … more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized ... reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison...Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent… more
- Children's Mercy Kansas City (Kansas City, MO)
- …Oversees and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, ... and related software applications and implementations. + Engages in utilization review committee. Qualifications + Master's Degree...Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse … more
