- Boston Childrens Hospital (Boston, MA)
- …appeals of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital 's discharge planning case ... nursing experience required, pediatric experience preferred. Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred.… more
- Mad River Community Hospital (Arcata, CA)
- …Profession RN Specialty Case Manager RN Job ID 16149898 Job Title RN - Utilization Review RN Weekly Pay $2205.3 Shift Details Shift Days 3x12 Scheduled Hours ... 36 Job Order Details Start Date 03/05/2025 End Date 06/04/2025 Duration 13 Week(s) Client Details City Arcata State CA Zip Code 95518 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 ... (Seattle, Tacoma, Bellevue, WA CBSA) to receive this designation. Named by Becker's Hospital Review among the nation's 100 great community hospitals for 2024… more
- Kaiser Permanente (Los Angeles, CA)
- …the general and specialized principles, practices, techniques and methods of Utilization review /management, discharge planning or case management. Working ... during case review or other activities. Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources… more
- Valley Health System (Paramus, NJ)
- POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on ... appropriate utilization review guidelines and documentation in accordance...and with multidisciplinary team members. Job Location The Valley Hospital -Paramus Shift Day (United States of America) Joining Valley… more
- HEALTH FIRST CAREERS (Melbourne, FL)
- Job Requirements POSITION SUMMARY The Utilization Review (UR) nurse performs medical necessity reviews on all payer admissions to determine appropriate admission ... of care including the appropriate length of stay, patient status management, resource utilization and discharge planning for all hospital admissions. The UR… more
- MEITHEAL PHARMACEUTICALS INC (Los Angeles, CA)
- …phase, 22 additional products planned for launch in 2025, and 24 products under review by the FDA. Meitheal's mission is to provide easy access to fairly priced ... toward a common goal, for the greater good. Position Summary The Key Account Manager (KAM) role is focused on creating opportunities and generating demand for a new… more
- Baystate Health (Springfield, MA)
- The RN Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and financial outcomes of a designated population ... of patients. The Hospital Case Manager is responsible for overseeing...Competencies: Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by… more
- UHS (Las Vegas, NV)
- …minimum three years experience in varied clinical settings. Two years experience in Utilization Review , Utilization Management or Case Management preferred. ... that serves more than two million people in Southern Nevada. Starting with Valley Hospital Medical Center in 1979, the Valley Health System has grown to include… more
- Seattle Children's Hospital (Seattle, WA)
- …setting Clinical experience caring for children with medical complexity Current or previous hospital case management or utilization review experience Current ... or previous case management or utilization review leadership experience Compensation Range $115,277.00 - $172,915.00 per year Salary Information This… more
- Mount Sinai Hospital (New York, NY)
- Job Description Process Improvement Manager I-Health System Operations -Corporate-Full-Time Days-Hybrid The Health Systems and Process Improvement (HSPI) Manager ... that advance Mount Sinai Health System's strategic priorities. The HSPI Manager II plans, manages and executes complex improvement initiatives and performance… more
- Sharp HealthCare (La Mesa, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... -REQUIRED Preferred Qualifications Bachelor's Degree in Nursing Certified Case Manager (CCM) - Commission for Case Manager ...and provides information to the department head as indicated. Utilization review and utilization management… more
- Glens Falls Hospital (Glens Falls, NY)
- …patient condition that may necessitate treatment change and will attend regular case review meetings. The Care Manager will work closely with the ... The Impact You Can Make Team Impact The Care Manager will be assigned to manage their own patient...Interdisciplinary Team to ensure appropriate utilization and provision of resources for patients including referrals… more
- HCA Florida North Florida Hospital (Gainesville, FL)
- …the medical needs for patients Certification in Case Management, Nursing or Utilization Review is preferred Florida RN license and/or approved multistate ... Details Client Name HCA Florida North Florida Hospital Job Type Permanent Offering Nursing Profession Registered...Type Permanent Offering Nursing Profession Registered Nurse Specialty Case Manager Job ID 16665674 Job Title Registered Nurse -… more
- Phoenix Children's Hospital (Phoenix, AZ)
- …and annual evaluations. Participates in and ensures evidence based literature review to improve clinical care, policies and procedures, guidelines, programs and ... accuracy of patient charges and justification of supply and equipment utilization . Participates in cost containment. Works collaboratively as part of clinical… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered ... CCM-RN) preferred. Proven leadership experience in acute care, utilization review , case management. Strong working knowledge of hospital billing, managed… more
- AdventHealth (Altamonte Springs, FL)
- …medical necessity, CMS CoP for Discharge Planning and care coordination. The RN Care Manager is knowledgeable of post- hospital care and services available to the ... in the community of Altamonte Springs, our facility is consistently named "Best Hospital " for overall quality, reputation, doctors and nurses by local residents As… more
- AdventHealth (Hinsdale, IL)
- …Supervisor or Manager and is responsible for patient evaluations of post- hospital needs; development of a transition of care plans and initiation of the ... CMS CoP for Discharge Planning and care coordination. The Social Work Care Manager is knowledgeable of post- hospital care and services available to the… more
- Valley Presbyterian (Los Angeles, CA)
- …chart reviews to managed care companies (MCO)/medical groups according to payor contract/ hospital policy. Document the review was called/faxed to MCO/medical ... Job Summary: As a Registered Nurse/Case Manager , Case Management Unit, you will play a...customer satisfaction in the most cost-effective manner. Responsible for Utilization Management, Case Management, and Discharge planning activities on… more
- Northwell Health (Riverhead, NY)
- …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. Keeps ... another level of care according to regulatory standards. * Performs concurrent utilization management Conducts chart review for appropriateness of admission and… more
