- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- Job Description Grievance & Appeals Nurse Specialist At Sunshine Enterprise USA, we're not just a company; we're a community of dedicated professionals committed ... explore our current job opportunities below. Job Title: Grievance & Appeals Nurse Specialist Department(s): Grievance and Appeals Resolution Services (GARS)… more
- Lifepoint Health (Louisburg, NC)
- Description Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound ... an employee but as a person. As a registered nurse (RN) joining our team, you're embracing a vital...the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate… more
- MedStar Health (Baltimore, MD)
- Candidates with previous Utilization Review or Denials/Appeals experience preferred General Summary of Position Responsible for coordinating and monitoring the ... and retrospective denial of payments for services provided. Collaborates with physicians, Utilization Review RN's, Case Managers, revenue cycle personnel and… more
- Northwestern Memorial Healthcare (Winfield, IL)
- …Preferences for the Emergency Room and the Pediatric Emergency Room Trauma Nurse Specialist (TNS) Emergency Communications Registered Nurse Certified ... our employees. Ready to join our quest for better? Job Description The Staff Nurse Inpatient reflects the mission, vision, and values of NM, adheres to the… more
- Miami Dade College (Miami, FL)
- …Clinical Simulation Closing Date Open Until Filled FLSA Status Non-Exempt First Review Date June 16, 2025 Position Overview This Part-Time Clinical Simulation ... Technical Specialist provides technological assistance in developing evidence based scenarios...for staff, faculty and students Maintains records of laboratory utilization ; makes recommendations for budget and purchases of equipment,… more
- Conifer Health Solutions (Sherwood, AR)
- …DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Record Review : Completes initial medical records reviews of patient records within 24-48 ... assignment, risk of mortality and severity of illness; and (b) initiate a review worksheet. Conducts follow-up reviews of patients every 2-3 days to support and… more
- Roper St Francis Healthcare (Charleston, SC)
- …critical thinking. Ability to run effective shift safety huddles, report safety concerns, review device utilization , report staffing concerns, and review ... following established standards and practices in accordance with the South Carolina Nurse Practice Act. Applies professional nursing theory and practice to assess,… more
- Children's Mercy KC (Kansas City, MO)
- …and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff Analyzes, evaluates, ... support tools and related software applications and implementations. Engages in utilization review committee. Qualifications Master's Degree MSN or Masters… more
- Regency Integrated Health Services (Cuero, TX)
- …Rehabilitation Center - Cuero, TX Position Type Full Time Job Category Nurse Description Primary Responsibilities Responsible for the coordination of the Resident ... and benefit period through regular communications with Regional Care Management Specialist , Business Office and external Case Managers. Gathers information needed… more
- CAMC Health System (Weston, WV)
- Job Summary Under the direction of the Nurse Director, the Nurse Manager is responsible for the direction and coordination of all functions in the unit to ... Provides leadership for nursing staff to meet the needs of onboarding nurses, nurse graduates, and experienced nurses in a variety of modalities including but not… more
- Small Door Veterinary (Washington, DC)
- …in invoicing Manage and optimize the appointment schedule, including surgery and specialist bookings, with an eye towards maximizing utilization of our ... Lead team meetings in collaboration with the Managing Veterinarian and Managing Nurse , ensuring relevant information sharing Uphold a culture of safety, compliance,… more
- Lutheran Services Florida (Tampa, FL)
- …communities are vibrant . LSF is looking for a talented Healthy Start Care Coordinator Specialist who wants to make an impact in the lives of others. The ideal ... Start Prenatal and Infant Pathways, and Inter-conception Care Counseling, and utilization of screening tools to identify specific risk factors including maternal… more
- Kaweah Health (Visalia, CA)
- …experience must be as a Registered Nurse in acute care setting. CA Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP) within three years of date ... is to provide ongoing assessment of staff member educational needs. Through utilization of adult learning principles, to strategically design, implement and evaluate… 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… 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 : ... (2nd week) ; rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and… more
- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...Registered Nurse (RN) Utilization Review Job Type: Full Time...of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Specialist + Oakland,...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
