- 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
- Strategic Staffing Solutions (Detroit, MI)
- … for one of our largest clients in Detroit, MI! Job Title: Registered Nurse -Medical Policy Specialist Duration: 6 months W2 contract engagement, no C2C. ... Medicare Advantage experience working for a health insurance provider. Utilization Management experience is a plus. Engagement Description: We...We are seeking a highly skilled and experienced Registered Nurse (RN) to join our team as a Medical… more
- Conifer Health Solutions (Federal Way, WA)
- …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
- UHS (Palmdale, CA)
- …retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services.Responsible for improving the overall ... Healthcare is seeking a Full-Time Remote RN Clinical Documentation Integrity Specialist . Duties include but not limited to: Providing clinically based concurrent… more
- NYC Health Hospitals (New York, NY)
- …above; or 4.Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or 5.Successful completion of ... to clarify Diagnoses. Reconcile DRG with the Coders to avoid mismatches daily. Review Denials as assign. SUMMARY OF DUTIES AND RESPONSIBILITIES: 1. Apply knowledge… more
- Northwell Health (Manhasset, NY)
- …transplant team and provide pharmacy recommendations Education and development of nurse , physician and pharmacy staff development pertaining to transplant and ... and research. Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy,… more
- Roper St Francis Healthcare (Summerville, 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
- Northwestern Memorial Healthcare (Geneva, IL)
- …Preferences for the Emergency Room and the Pediatric Emergency Room Trauma Nurse Specialist (TNS) Emergency Communications Registered Nurse Certified ... - 7:30a with every third weekend (Friday and Saturday nights) required. The Registered Nurse Inpatient reflects the mission, vision, and values of NM, adheres to the… more
- Georgia Department of Community Health (Atlanta, GA)
- …federal rules and regulations. Develops, implements and evaluates the surveillance of utilization review process to ensure quality services. Monitors, tracks, ... Nurse /LPN in the field of mental health or Drug Treatment. Experience in utilization review and/or quality assurance in a healthcare setting. Experience in… 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
- 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
- CAMC Health System (Morgantown, WV)
- Job Summary Under the direction of the Nurse Director, the CNC is responsible for the direction and coordination of all functions in the unit during his/her shift to ... include ongoing assessment of the quality of patient care provided. The Clinical Nurse Coordinator is the resource for the staff assisting with educational needs as… 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
- Generis Tek, Inc. (El Paso, TX)
- …calls with patients and/or families as needed You will complete accurate and timely utilization review of patient charts to insure appropriate utilization of ... To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Anshik Kulshrestha at email address ###@generistek.com can be reached on #… 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
