- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... + FTE:1 + Posted:Today **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate… more
- Matrix Providers (Aurora, CO)
- …in a direct patient care clinical setting and 12 months consecutive experience in utilization management , utilization review or case management ... Utilization Review Nurse (RN) Location: Aurora,...Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education: Bachelor-s degree in nursing.… more
- Intermountain Health (Murray, UT)
- …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... regarding authorizations, approved treatment plan and length of stay. **Skills** + Utilization Management + Clinical Expertise + Independent and autonomous +… more
- Aspen Medical (Aurora, CO)
- …36 months total nursing experience in a direct patient care clinical setting. Must have utilization management , utilization review or case management ... JOB AD: Registered Nurse- Utilization Management Introduction : Aspen Medical... (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP), Certified Informatics Nursing,… more
- Wellpath (Lemoyne, PA)
- …care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders,… more
- Actalent (Sunrise, FL)
- …department activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines ... education + Valid Florida Driver's License + Knowledge of case management and utilization review concepts + Familiarity with Florida Medicaid Program… more
- CVS Health (Harrisburg, PA)
- …work Monday through Friday 8:30-5pm EST. No weekends or holidays. - 1+ years of utilization review / utilization management required - 3+ years of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Insight Global (Philadelphia, PA)
- …License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... local providers Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors Degree null We are a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of ... review determinations. + Provides input into the utilization management program policies and procedures. +...Qualifications) + Minimum 2-3 years of experience in medical management , utilization review and case… more
- Guardian Life (Austin, TX)
- …dental product and to assume responsibility for the functions of utilization management and utilization review , as requested by the Dental Director, ... as needed (eg Specialty Referral Guidelines) with guidance from the Quality and Utilization Management Manager + Demonstrate expertise in QMP processes and… more
- Actalent (Rancho Cordova, CA)
- …follow-up actions to ensure quality care access. Essential Skills + 1 year of Utilization Review / Management experience + Proficiency in Utilization ... Collaboration with medical directors, coordinators, and leadership is essential to review , process, and provide a final determination for all clinical appeals… more
- CCSI INC (Johnson City, NY)
- …. + Design and implement monitoring protocol to ensure appropriate utilization management and utilization review procedures are in place. + Respond ... communication with partnering agencies, coordination and facilitation of complex case review sessions and partnering with existing Department staff to build the… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... level of care, and attainment of financial goals. Reporting to the Sr. Director/AVP/VP Utilization Management , the role of the Director for Utilization … more
- Tenet Healthcare (Detroit, MI)
- …and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of ... initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations and standards, including ensuring compliance… more
- Zurich NA (Raleigh, NC)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review , catastrophic or disability experience + 5 ... AVP, Utilization Review & Pharmacy 123092 Zurich...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print...Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually… more
- Guthrie (Sayre, PA)
- … of all operational aspects for Care Coordination including, but not limited to Case Management , Utilization Review (UR), Utilization Management ... in and experience of payer contract language, as it relates to utilization management . Can navigate through the requirements imposed by all payers. Prior… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance… more
- Beth Israel Lahey Health (Burlington, MA)
- …the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- Intermountain Health (Las Vegas, NV)
- …interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network management ... finance. As the Medical Director for Utilization Management , you are responsible, in partnership with MG Clinical...order to be considered for the position.** Performs medical review activities pertaining to utilization review… more