- CoxHealth (Lake Spring, MO)
- …feedback for the following Committees: 1) Coding and Documentation Committee 2) Utilization Review Committee 3)SOI Scorecard Committee 4) Educational sessions ... order to analyze data to determine when to mentor and educate CDI Specialist (s) to improve their practice. Additionally will be responsible for assisting providers… 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
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed… 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
- YesCare Corp (Brentwood, TN)
- …+ Assist in completion of special projects on an as needed basis. **Key Qualifications:** + Registered Nurse ( RN ) active license + No less than 5 years' ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. +… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- CareFirst (Baltimore, MD)
- …Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze...in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse -… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/ RN responsibilities ... + **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred...Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St… 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
- Bon Secours Mercy Health (Cincinnati, OH)
- …hospitals, care sites and clinicians are recognized for clinical and operational excellence. RN Quality Specialist Summary: Ensures the delivery of high quality, ... improvement committees and projects as needed. Supports Medical Staff Quality and Peer Review . Essential Functions: + Collaborates and acts as a resource to the… more
- Roper St. Francis (Charleston, SC)
- …Charge Nurse I. Experience: 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
- Cedars-Sinai (Los Angeles, CA)
- …Los Angeles Fair Chance Initiative for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days ... care field preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review … more
- MyFlorida (Land O' Lakes, FL)
- …that all verbal orders, including telephone orders from attending physicians are received by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50000070 Date:...current status and providing supervision and guidance to the RN , LPN, CNA and other Allied Health Care Professionals.… more
- MyFlorida (Orlando, FL)
- …that all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . + If no RN is available, receive all ... resident's status, and providing supervision and guidance to the Registered ( RN ), Licensed Practical Nurse ...that the residents are receiving total nursing care. + Review shift assignments and ensure that the assignments reflect… more
- MyFlorida (Port Saint Lucie, FL)
- …that all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . + If no RN is available, receive all ... SENIOR REGISTERED NURSE SUPV Date: Oct 28,...resident's status and providing supervision and guidance to the RN , LPN, CNA, and other Allied Health Care Professionals.… more
- MyFlorida (St. Augustine, FL)
- …that all verbal orders, including telephone orders from attending physicians are reviewed by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50950032 Date:...resident's status, and providing supervision and guidance to the RN , LPN, CNA and other Allied Health Care Professionals.… more
- MyFlorida (Port Charlotte, FL)
- …all verbal orders, including telephone orders from attending physicians, are received by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50009026 Date:...resident's status and providing supervision and guidance to the RN , LPN, CNA, and other Allied Health Care Professionals.… more
- City of New York (New York, NY)
- …required; make professional recommendations accordingly. - Keep abreast of medical and utilization review techniques and developments relative to the nursing ... Nurse in the Bureau of Medical and Professional Review (BMPR) of Home Care Services Program. As the...- 50935 Qualifications 1. A valid New York State Registered Nurse License and completion of one… more
