- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Luke Staffing (Glendale, CO)
- …**Will consider Part Time and Full Time Applicants** **POSITION OVERVIEW:** The Registered Nurse ( RN ) will provide on-site professional nursing services ... ** REGISTERED NURSE ** **SITE OF SERVICE:** Department...of Veterans Affairs' Eastern Colorado Healthcare System (ECHCS). The RN will serve in the Office of Community Care… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Health Educator** supporting **Naval Medical Center San Diego, CA ... of other individuals performing similar services. ? Participate in peer review and performance improvement activities. ? Practice aseptic techniques as necessary.… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- … RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and network facilities to ... 8:00 AM - 5:00 PM CST (Flexible) **Responsibilities** A. Performs necessary review to ensure compliance with HHSC and other regulatory entities + Collaborate:… more
- Stanford Health Care (Palo Alto, CA)
- …Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the ... If you're ready to be part of our legacy of hope and innovation,...under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse… more
- Stanford Health Care (Palo Alto, CA)
- …their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or ... If you're ready to be part of our legacy of hope and innovation,...practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... If you're ready to be part of our legacy of hope and innovation,...include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review … more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... If you're ready to be part of our legacy of hope and innovation,...include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review … more
- Commonwealth Care Alliance (Springfield, MA)
- …success. + Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges. + Represent ... Lead the monitoring and analysis of provider performance using utilization , quality, and member experience metrics. + Collaborate with...self-motivated, with the ability to work independently and as part of a team to meet departmental goals. +… more
- Commonwealth Care Alliance (Boston, MA)
- …understanding of CCA's mission, value-based approach, and expectations for quality, utilization , and member experience. - Address provider inquiries related to care ... coordination, utilization management, and program participation, collaborating with internal teams...BH and Health Home providers. - Participate in case review meetings and rounds as needed to enhance coordination… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …preauthorization, outpatient and inpatient management, case management, retrospective claim review , and delegated management oversight. + Participate in the ... and direction of work processes to support cost and utilization variations. + Participate in the development, implementation, and...deficits with improvement plans and consistent follow-up. + As part of this role, you may be assigned internal… more
- Parexel (Trenton, NJ)
- …understanding interdependencies. Define mitigations and drive resolution with cross-functional stakeholders as part of the Risk Management Plan. + Review and ... practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable...ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or… more
- Providence (Mission Hills, CA)
- **Description** ** RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part - time and will work 8-hour, ... must empower them. **Required Qualifications:** + Associate's Degree - Nursing. + California Registered Nurse License upon hire. + 2 years - Experience working… more
- Swedish Health Services (Seattle, WA)
- **Description** ** Utilization Review RN @ Swedish Medical Center** ** Part time 0.7 FTE** **Evening Shift** **Fantastic benefits and compensation package ... focus on what really matters - our patients.** The Utilization Review (UR) Nurse has...an accredited school of nursing. + Upon hire: Washington Registered Nurse License + 3 years … more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts ... this position is able to cover a multitude of utilization review functions through point of entry,...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- AdventHealth (Tampa, FL)
- …and other diseases. **The role you'll contribute:** The Utilization Management nurse uses clinical expertise to review patient records in the emergency ... providers in emergency department setting. Utilize critical thinking and expertise in utilization review regarding medical necessity, patient status, level of… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Part -Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or… more
- Penn Medicine (Lancaster, PA)
- …placement in position for incumbents who started after 07/01/2020. + A graduate registered nurse may only practice professional nursing under supervision and if ... the graduate registered nurse holds a current temporary practice... nurse is practicing. + All Clinical Nurse 1 RN 's will be required to… more
- HCA Healthcare (Richmond, VA)
- …set us apart from any other healthcare provider. We are seeking a(an) Case Manager Registered Nurse RN PRN to join our healthcare family. **Benefits** ... At Henrico Doctors' Hospital, our nurses play a vital part . We know that every nurse 's path...for patient care. Apply today for our Case Manager Registered Nurse RN PRN opportunity.… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Case...growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion ... dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the...and is determined by employment status Job Description: The RN Case Manager is responsible to facilitate care along… more
