- Berkshire Hathaway Homestate Companies (Omaha, NE)
- …in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker's treatment ... skills in this growing industry. No UR experience required! Review complex workers compensation medical treatment requests...attorneys. Act as a medical resource in regards to utilization review to Claims Support Nurse… more
- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …judgment, and meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse , a sharp case manager, or a ... and consistently in EMR systems and meet quality and productivity metrics. Escalate complex cases for Medical Director review as needed. We're Hiring for:… more
- Riverside County, CA (Moreno Valley, CA)
- …Health System-Medical Center is seeking an Assistant Director of Case Management and Utilization Review to join our UR Case Management Department located in ... in nursing is preferred. Experience: Three years of charge nurse or supervisory experience working as a registered ...acute care hospital. Professional experience in case management and utilization review in a hospital is preferred.… 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 ... for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our payers and… 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 ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management, Nurse Case Manager/Caseworker, and/or Process… more
- 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 to ... our current job opportunities below. Job Title: Grievance & Appeals Nurse Specialist Department(s): Grievance and Appeals Resolution Services (GARS) Reports to:… more
- Compu-Vision Consulting, Inc. (Canton, GA)
- OCCUPATIONAL SUMMARY The Registered Professional Nurse at Northside Hospital independently plans and provides professional nursing care to patients in accordance ... and in accordance with the scope of practice as defined by the Georgia Nurse Practice Act. The American Nurses Association's (ANA) Nursing: Scope and Standards of… more
- Kaiser Permanente (Olympia, WA)
- …members. Preferred Qualifications: Minimum two (2) years of RN experience in utilization review , ambulatory case management, care coordination or disease ... Description: RN CASE MANAGER LIAISON NURSE - INPATIENT DISCHARGE PLANNING ** SIGN-ON BONUS...of optimal patient health care outcomes while ensuring appropriate utilization of health care resources. Working closely with primary… more
- Elevance Health (Indianapolis, IN)
- …granted as required by law. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, ... and/or Provider on select cases, such as cases the nurse deems particularly complex , concerning, or unclear....experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- US Tech Solutions (Schenectady, NY)
- …you have experience with Prior Authorization? Do you have experience with Utilization Review ? Do you have an Active Registered Nurse License? About US Tech ... MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. MUST HAVE UM experience, inpatient utilization management review . MUST HAVE 1 YEAR OF UTILIZATION … more
- Team Select Home Care (West Palm Beach, FL)
- …Control Plan, EMS Plan and the Compliance Plan Participates in clinical record/ utilization review of medical records and quality assurance and performance ... purpose? Join Team Select Home Care as a Registered Nurse (RN), where you'll bring comfort and confidence to...to families by delivering compassionate one-on-one care to medically complex children and adults in the comfort of their… more
- Veterans Health Administration (Phoenix, AZ)
- …limited to: Patient Aligned Care Team (PACT) Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based gender-specific care to ... of licensed vocational nurses/nursing assistants, as appropriate to the setting. This nurse provides direct Veteran care and care coordination, as it pertains, to… more
- Sutter Health (Burlingame, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of ... care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely… more
- Hackensack Meridian Health (Eatontown, NJ)
- …healthcare and serve as a leader of positive change. The Registered Nurse , RN Community Based Care Management provides direct support to physician practices ... and identifies complex patients or patients with targeted conditions who require...require care management, coaching, education, supervision, and/or support. The nurse will coordinate care, resources & services across the… more
- Veterans Health Administration (Albany, NY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. This… more
- Marshall Health Network (Point Pleasant, WV)
- …and the administrator on-call. Additionally, this position will include knowledge of Utilization Review rules and regulations as they assist physicians and ... staff on Written anecdotes are passed on to the nurse director to be used as part of performance...status to patients (observation/admission) Monitor documentation for adherence to Utilization rules and Perform other duties as Adheres to… more
- Team Select Home Care (Atlanta, GA)
- …skills according to established procedures before performing new skills Participates in peer review , utilization review and QAPI activities as assigned ... Hours *Weekly Pay Are you a compassionate Licensed Practical Nurse (LPN) ready to make a real difference in...provide one-on-one care to pediatric and/or adult patients with complex medical needs in the comfort of their homes.… more
- Veterans Health Administration (Syracuse, NY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. Assumes responsibility for the coordination of care focused… more
- Tenet Health (Detroit, MI)
- …model, staffing and skill mix, complex Case Management, and centralized utilization review *Participate in new hospital Director of Case Management selection ... and objectives that support overall strategic plans of the Case Management and Utilization Review strategy *Lead Group hospital Case Management and … more
- Emonics LLC (San Francisco, CA)
- …care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
