- Mayo Clinic (Rochester, MN)
- …physicians and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review , including concurrent admission status and ... resource utilization , and clinical documentation. The RN Case Manager will function within the Mayo...within a creative and challenging work environment. Experience in utilization review , ability to navigate medical records,… more
- University of Utah Health (Salt Lake City, UT)
- …reporting of time and attendance of direct reports. + Functions as Case Manager and/or Utilization Review Nurse as necessary. + Tracks and analyzes ... Case Manager quality of service and utilization statistics. + Works collaboratively with information systems personnel as needed to implement case … more
- Penn Medicine (Philadelphia, PA)
- …+ Registered Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + ... * And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and third-party payors. We believe that the best care… more
- Ochsner Health (Lafayette, LA)
- …license in state of practice. Preferred - Commission for Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified Professional ... in the delivery of patient care. Preferred - Experience in case management or utilization review . **Certifications** Required - Current Registered Nurse… more
- Mohawk Valley Health System (Utica, NY)
- …to our diverse member population. Provides direct oversight of the case manager 's daily operations of utilization review practice, processes and ... Management - SNH is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties… more
- University of Miami (Miami, FL)
- …System Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. ... and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Utilization Review Case Manager ... of Miami is currently seeking a Prior Authorization Nurse Case Manager . The incumbent purose is to...forth by the payer or clinical guidelines + Accurate review of coverage benefits and payer policy limitations to… more
- Ellis Medicine (Schenectady, NY)
- …by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social ... SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for ...inpatient experience in a hospital environment preferred. + Previous case management, utilization review , and… more
- Nuvance Health (Sharon, CT)
- …health to the patient. Responsibilities for this full time RN Case Manager position includes include utilization review , discharge planning and care ... license, Bachelors Degree in Nursing or related field, a minimum of 1 year Case Management experience in an acute care setting. CCM, PRI and Screen certifications… more
- Amergis (French Camp, CA)
- …hours per week RNs will be doing denials, discharge planning, and utilization review **Needs Case Manager Experience in ACUTE setting** Current Discharge ... Planning experience Denials experience Utilization review experience InterQual experience Working with...experience with PERFORMANT or CDCR denials DESIRED The RN Case Manager is responsible for coordinatingcontinuum of… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review , and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... issues. To support the mission of Helio Health, theUtilization Case Manager will enhance the program's efforts...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.Thisis a full-time role. *Purpose of this position: ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/ case - manager ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Minimum 5 years of acute care experience preferred.2. Certified Case Manager (CCM) certification preferred.3. At least… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based...days of hire + One of the following: American Case Management, Certified Case Manager … 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...administration or related field preferred or commensurate experience and Case Management Certification required + Minimum of 3 years… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... reconsiderations or coordinating peer-to-peer reviews. + Communicates effectively with utilization review coordinators, case managers,...and/or Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited … more
- Virtua Health (Pennsauken, NJ)
- …resource group and payers.Documentation* Appropriate and complete documentation of clinical review and denial management in the case management documentation ... UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a resource to… more
- Behavioral Center of Michigan (Warren, MI)
- …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... Under general supervision, the Utilization Review Coordinator provides professional assessment,...those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs… more
- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and...of patient data and treatments. Communicates daily with the Case Manager to manage level of care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts… more
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