- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR and… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management … more
- Diversicare Healthcare Services & Diversicare Ther (Birmingham, AL)
- …to the managed care plan. * The case manager provides center case management / utilization review and discharge planning to assure that the patient ... Diversicare Healthcare Services is seeking an outstanding RN Case Manager that has a passion for providing the highest...and satisfaction, promote continuity of care and cost effectiveness, utilization review and management as… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day ... 15, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN...in orientation of fresh staff as requested by the Manager of Utilization Management . 17.… more
- Dartmouth Health (White River Junction, VT)
- Utilization Review Case Manager ...Review Case Managersat VNH focus on providing pain management and comfort for patients with terminal or chronic ... – Home Health PRN, Days Why work as a Utilization Review Case Manager at...plan of care, including but not limited to: order review , resource management , measuring outcomes, and communication… 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 ... effective communication with patient care team members related to utilization management + Verify medical necessity of...and other areas as assigned + Serve on the Utilization Review Committee for the Scottish +… more
- Tufts Medicine (Burlington, MA)
- …and oversight to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible for compliance with CMS Conditions ... Review and Discharge Planning including implementation and annual review of the Utilization Management ...the Utilization Management Committee. The Utilization Management Operations Manager follows… more
- Ascension Health (Pensacola, FL)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... **Details** + **Department: Utilization Review ** + **Schedule: Full time...the areas of utilization criteria, appeal and review process, and case management system documentation.… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to... reports to the Director of Utilization Management * Oversees clinical decision review for… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Elevance Health (Morgantown, WV)
- RN Utilization Management / Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... : Monday through Friday, 8am - 5pm The **Medical Management Nurse** (Medicaid Utilization Review )...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209331/case- manager %2c-rn utilization - review ... Applicants:https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… 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 ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… 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 ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Healthfirst (IA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review , ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you...care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Baptist Memorial (Meridian, MS)
- …Minimum Required: RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer ... Overview RN Utilization Review Weekender Job Code: 22818...management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Job Responsibilities + Completes and… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,… 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 to ensure that the hospitalization is warranted… more
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