- Prime Healthcare (Weslaco, TX)
- …Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered- nurse -case- manager utilization ... perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.… more
- CareOregon (Portland, OR)
- …Manager Direct Reports Registered Nurse - Clinical Quality Assurance, Registered Nurse - Utilization Management II Manager Title Director, Quality ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Quality Assurance Manager , Clinical Systems Requisition # 25017 Exemption Status Exempt Management Level… 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 care...the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs &… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... services. Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an interdisciplinary team,… 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 Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… 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) is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Dignity Health (Mesa, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Clinical Care Reviewer refers the member to a Special Needs/Pediatric Shift Care Case Manager and works collaboratively with that Case Manager to ensure the ... longer needed or until the member's 21st birthday. ;The nurse will maintain current knowledge and understanding of the...a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization.… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd party… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more
- Dartmouth Health (White River Junction, VT)
- … – Home Health PRN, Days Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire? * You experience ... one 4-hour flex shift to be discussed with hiring manager . Locations: * Fully remote work in all statesexcept:...CT, MA, MD, NJ, NY, OH, RI, WY. Visiting Nurse and Hospice for VT & NH covers more… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Onsite Position Position Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure the appropriateness for the ... to meet the healthcare needs of the patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and Case Management. +… more
- Scottish Rite for Children (Dallas, TX)
- …committed to giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital Additional ... + Maintain effective communication with patient care team members related to utilization management + Verify medical necessity of all Inpatients using established… more
- Healthfirst (IA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate, monitor,… 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...to prioritize multiple tasks and role components. + Registered Nurse (RN) Required + Accredited Case Manager … more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209331/case- manager %2c-rn utilization ... perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/208989/case- manager -%28rn%29 utilization ... perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.… more
- Alameda Health System (Oakland, CA)
- …requirements. 16. Participate in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge of current trends and ... System Utilization Management SUM Utilization Review RN...system. 9. Conduct concurrent and admission reviews of patient records to assess medical necessity and adherence to evidence-based… more
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