- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse, a sharp case manager, or a behavioral health ... is your moment. As a Clinical Care Reviewer , you'll evaluate inpatient, outpatient , pediatric, or... clinical leadership with purpose. What You'll Do: Review inpatient, outpatient , and behavioral health service… more
- Geisinger (Tunkhannock, PA)
- …Posted: 04/07/2025 Job ID: R-76487 Job Summary Provides direct patient care and clinical support for physicians and other providers in the outpatient setting. ... the health care team under the direction of the provider. Performs clinical duties such as preparing patients, collecting and reviewing pertinent information,… more
- Geisinger (Danville, PA)
- …Team Date Posted: 04/02/2025 Job ID: R-75902 Job Summary Geisinger offers outpatient Certified Medical Assistants a $3,000 bonus for eligible candidates. Geisinger ... ambulatory setting.? Job Duties Provides direct patient care and clinical support for physicians and other providers in the... support for physicians and other providers in the outpatient setting. Functions as an integral member of the… more
- EvergreenHealth (Kirkland, WA)
- …provides intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support, and training of team ... arrange for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our… more
- Discovery Behavioral Health (Portland, OR)
- …of the clinical team in their absence. Communicates with the Utilization Review Department and Business Department regarding authorization and payment. ... week. Facilitates multi-family groups, family program, and/or family weekend. Provides utilization reviews to insurance companies, providing appropriate clinical … more
- Geisinger (Philipsburg, PA)
- …work in a progressive learning environment while providing top-notch care in an outpatient clinical setting.? Graduate of an accredited 1-year certificate or ... Team Date Posted: 03/28/2025 Job ID: R-75710 Job Summary Geisinger offers outpatient Certified Medical Assistants up to a $3,000 bonus for eligible candidates.… more
- Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Quality & Patient Safety Nurse Manager - Utilization Management functions as a clinical expert and is responsible and accountable ... healthcare settings. Knowledge and ability to apply InterQual criteria, utilization management processes, clinical documentation requirements, current standards… more
- Veterans Health Administration (Phoenix, AZ)
- …Duties include but not limited to: Patient Aligned Care Team (PACT) Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based ... education, orientation, competencies and providing quality improvement and outcomes utilization . Demonstrates leadership in delivering and improving holistic, primary… more
- County of Los Angeles, CA (Los Angeles, CA)
- …in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the ... : Assists in planning, organizing, and directing a program of professional clinical social work services for inpatients, outpatients, and their families at a… more
- The Ohio State University (Dublin, OH)
- …contact ###@osu.edu. If you have questions while submitting an application, please review these frequently asked questions. Current Employees and Students: If you ... all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may… more
- Veterans Health Administration (Port Charlotte, FL)
- …of consideration - Current Permanent Bay Pines employees including Community Based Outpatient Clinics (CBOCs). Second area of consideration - Current permanent VA ... to all other applicants. Videos Duties Home Based Primary Care (HBPC) Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based… more
- Northpoint Recovery Holdings, LLC (Boise, ID)
- …participate in the quality assurance and compliance activities of the facility Provide clinical updates to utilization review and representatives of managed ... Job Title: Outpatient Therapist/Counselor (PRN) Reports To: Program Director Location:...to individuals and families Coordinate all aspects of direct clinical care from admission to discharge Consult with the… more
- Kaiser Permanente (Ontario, CA)
- …the general and specialized principles, practices, techniques and methods of Utilization review /management, discharge planning or case management. Working ... as needed for outside services for patients/families. Conducts daily clinical reviews for utilization /quality management activities based on… more
- Central Maine Healthcare (Lewiston, ME)
- …Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical review to assess for medical necessity of outpatient and ... RN licensure. *Three (3) or more years of previous experience in Utilization Management and/or Care Management. *BSN preferred *Certified Case manager required… more
- Veterans Health Administration (Washington, DC)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... daily needs of the clinic, Monitoring both inpatient and outpatient appointments in areas of responsibility; Verifying and updating...and the flexible use of a wide range of clinical flow processes relating to access to care across… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …rising risk, and high-risk members' utilization of services in all settings ( outpatient , inpatient, concurrent review , and transitions of care). 3. Take a ... Medi-Cal program Administrative practices and procedures (including but not limited to utilization review , peer review , credentialing and risk management;… more
- Veterans Health Administration (Bedford, MA)
- …the data into VISTA if applicable. Promotes Veterans registration for and utilization of MyHealthyVet (MHV) and kiosks usage. Follows procedures regarding Community ... doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal… more
- UnitedHealth Group (Metairie, LA)
- …and national Health Care Affordability Initiatives in order to achieve inpatient and outpatient utilization and affordability goals Clinical Excellence - The ... oversight and guidance around quality improvement, appropriate inpatient and outpatient utilization , affordability, growth, regulatory compliance, and health… more
- County of San Bernardino, CA (San Bernardino, CA)
- …with severely mentally ill older adults. Experience in quality assurance or utilization review activities. Experience with managed care or insurance plans, ... the Public Guardian is recruiting for a Pre-Li censed Clinical Therapist and Licensed Clinical Therapist* who...- $102,731.20 THE COUNTY OFFERS TWO LUCRATIVE BENEFIT PACKAGES Review the job-specific Benefit Summary by following this link.… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred Registered Nurse… more
