- Billings Clinic (Billings, MT)
- …and coordinates care with the RN Care Manager , Social Services Care Manager , Utilization Review RN, Physician Advisor and Care ... to join Billings Clinic for our outstanding quality of care , exciting environment, interesting cases from a vast geography,...high risk for readmission. * Interfaces effectively with the Utilization Review department to stay current on… more
- Dartmouth Health (White River Junction, VT)
- Utilization Review Case Manager –...patient satisfaction to guide patient care and utilization . * Completes clinical review of referrals and ... Home Health PRN, Days Why work as a Utilization Review Case Manager at...provided. * Coordinates and manages the patient’s plan of care , including but not limited to: order review… more
- Beth Israel Lahey Health (Burlington, MA)
- …The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse...care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ability to communicate… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Scottish Rite for Children (Dallas, TX)
- …We're committed to giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital ... Job Description: Duties/Responsibilities + Maintain effective communication with patient care team members related to utilization management...and other areas as assigned + Serve on the Utilization Review Committee for the Scottish +… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
- Ascension Health (Pensacola, FL)
- **Details** + **Department: Utilization Review ** + **Schedule: Full time days** + **Hospital: Ascension Sacred Heart Pensacola** + **Location: Pensacola, ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care ...facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing… more
- Commonwealth Care Alliance (Boston, MA)
- …health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge, Skills ... Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral...+ Interface with Primary/Interdisciplinary Care Team including Care Coordinator, Care Manager , and… more
- Alameda Health System (Oakland, CA)
- …trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care ) by participating in appropriate ... System Utilization Management SUM Utilization Review...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209331/case- manager %2c-rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical necessity and level of ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... to monitor appropriateness of admissions with associated levels of care and continued stay review . + Communication...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations ... is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual … more
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...standard criteria per payer guidelines + Prioritizes observation case review + Assists with level of care … more
- Beth Israel Lahey Health (Burlington, MA)
- …Care , Physician Advisors Works collaboratively managing the process of Utilization Review throughout the system **As a health care organization, we have a ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- AmeriHealth Caritas (Philadelphia, PA)
- …The Clinical Care Reviewer refers the member to a Special Needs/Pediatric Shift Care Case Manager and works collaboratively with that Case Manager to ... pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...legitimacy of hospital admission, treatment, and appropriate level of care . The UM RN leverages the algorithmic logic of… more
- Dignity Health (Mesa, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines...five (5) years of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or… more
- Elevance Health (Morgantown, WV)
- … management or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of ... Qualifications:** + Acute, hospital clinical experience, ie ER, critical care , ICU, etc. + Utilization Review...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
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