- Cedars-Sinai Medical Center (Los Angeles, CA)
- …Name Cedars-Sinai Medical Center Job Type Local Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 16715295 Job Title Registered ... Nurse - Utilization Review Weekly Pay $1940.0 Shift Details Shift 8hr...Skills Required: Experience Concurrent CDI specialist Skills Preferred: DRG audit skill Client Details Address 8700 Beverly Boulevard City… more
- Kaiser Permanente (Antioch, CA)
- …resources in assigned clinical areas to ensure appropriate assignment and utilization ; supervising the use and maintenance of equipment, supplies and medications; ... consideration compliance timelines and financial commitments; facilitating and maintaining utilization and productivity to achieve performance targets; maintaining and… more
- Kaiser Permanente (Oakland, CA)
- …resource needs in clinical areas to ensure appropriate assignment and utilization ; evaluating the use and maintenance of equipment, supplies and medications; ... issues to maintain compliance and regulatory standards, and reviewing prepared audit documentation, information, and reports; and overseeing the development of… more
- Kaiser Permanente (Martinez, CA)
- …resource needs in several clinical areas to ensure appropriate assignment and utilization ; managing the use and maintenance of equipment, supplies and medications; ... compliance and regulatory standards and developing procedures for preparing audit documentation, information, and reports; and contributing to the development,… more
- MedElite Group, LLC. (Hollywood, FL)
- …and behavioral health integration Monitor KPIs and team productivity using dashboards, audit tools, and quality metrics; provide regular reports to senior leadership ... of compliance, clinical excellence, and accountability Required Skills & Experience: Registered Nurse (RN) with an active license in good standing Proven leadership… more
- UHS (Riverside, CA)
- Responsibilities SUMMARY: The Delegation Oversight Nurse performs activities to assure compliance with Health Plan requirements. The Nurse will manage activities ... in areas such as - routine reporting, ad hoc reporting, annual oversight audit preparation, annual audit oversight completion, response to CAPs, and follow-up… more
- Southern Oaks Care Center (Pawnee, OK)
- …Functions Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. Ensure that ... (RAI) process. Ensure that all resident rooms, common areas, treatment areas and nurse 's stations are maintained in a clean, safe and sanitary manner. Assist to… more
- Commonwealth Care of Roanoke (Radford, VA)
- …and participate in the weekly QI/QM meeting. Conducts at least one complete skin audit for all patients. Review pharmacy services that includes but is not limited ... error process with the DON. Review destruction of medications with DON. Audit 2 systems per week utilizing the systems worksheet, report finding to… more
- Napa County, CA (Napa, CA)
- …Delivery System (DMC-ODS). This includes Quality Assurance, Quality Improvement, Utilization Review, Final Rule compliance, data reporting, and documentation ... This role ensures behavioral health services are compliant, well-documented, and audit -ready. The Manager drives quality strategy across systems, aligning local… more
- Kaiser Permanente (Baldwin Park, CA)
- …by: researching corrective action plan for areas of improvement identified through utilization review, clinical records audit , claim denials, member satisfaction ... improve the reporting and narrative summaries of improvements by integrating multiple utilization data reporting systems to develop and maintain a variety of… more
- Solaris HealthCare College Park (Winter Park, FL)
- …under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The position coordinates resource utilization , timely and appropriate care ... resident as soon as possible upon arrival, validating accuracy of essentials audit and implementation of risk reducing measures Oversees and evaluates systems to… more
- Georgia Department of Community Health (Atlanta, GA)
- …and treatment facilities, regulated entity operations and program management. Conducts utilization reviews, peer reviews, evaluation activities and all other reviews ... rules and regulations. Develops, implements and evaluates the surveillance of utilization review process to ensure quality services. Monitors, tracks, and maintain… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ And more **Description** We're seeking under the direction of the ** Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing ... duties and responsibilities: Participates in external reviews such as Medicare Recovery Audit Program or other third-party audit programs and defends Emory… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… more
- Ochsner Health (Lafayette, LA)
- …or other related MCO departments/functions. **Certifications** Required - Current registered nurse (RN) license in state of practice. *MSW accepted in lieu ... of registered nurse (RN) licensure. Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare Management (CPHM). **Knowledge Skills… more
- UPMC (Pittsburgh, PA)
- **Purpose:** Do you have experience with clinical appeals and utilization review? Are you an RN looking to grow your career? UPMC is hiring a full-time Revenue Cycle ... Clinical Review Nurse . This position works Monday through Friday during daylight...for you, apply today! **Responsibilities:** + Apply understanding of utilization management as it relates to the continuum of… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... as an employee, but as a person. As a*registered nurse (RN)*joining our team, you're embracing a vital mission...outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of… more
- Molina Healthcare (Oakland, CA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... agreement. Preservice and outpatient experience. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
