- UHS (Bethlehem, PA)
- …multi-disciplinary team while working in a state-of-the-art facility, including EPIC. The Utilization Review Director is responsible for overseeing the ... utilization review process, ensuring efficient and effective use of healthcare...utilization standards. The Director provides guidance to the utilization review staff, advises on improving productivity,… more
- Pharmacy Careers (Tampa, FL)
- Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review ... prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience.… more
- Surgery Partners (Bryan, TX)
- Job Summary: We are seeking a Part-Time Utilization Review Nurse to join our dedicated healthcare team. In this role, you will play a critical part in ensuring ... Registered Nurse (RN) license in the state of practice Experience in utilization review , acute hospital case management, or quality assurance is required 2+… 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 ... for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our payers and… more
- Medical Solutions (Omaha, NE)
- …CA is seeking its next amazing RN (Registered Nurse) to work in Case Management ( Utilization Review ). Read on if this sounds like your perfect fit! Nurses and ... allied healthcare professionals are in high demand nationwide, and our team of industry-leading, traveler-favorite recruiters can get you where you want to go - personally and professionally. Wherever you may roam, travel healthcare helps you hone your skills… more
- Alameda Health System (Oakland, CA)
- SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use of healthcare resources while ... current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in appropriate… 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 ... care including the appropriate length of stay, patient status management, resource utilization and discharge planning for all hospital admissions. The UR Nurse… more
- Freeman Health System (Joplin, MO)
- …quality healthcare solutions. Schedule: Part-Time 30 hours per week What You'll Do The Utilization Review Coordinator provides utilization review to ... assure patients are admitted to the hospital in the correct status according to applied criteria. They work closely with payers to assure correct authorization for admissions are given and if needed to appeal payer decisions. They also assure the system is… more
- Mad River Community Hospital (Arcata, CA)
- …Nursing 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
- Curative HR LLC (Austin, TX)
- …years of clinical practice experience. Minimum of 2-3 years of experience in utilization management, medical review , or prior authorizations within an insurance ... This pivotal role will be responsible for overseeing and performing utilization reviews, prior authorizations, and making crucial medical necessity determinations.… more
- American Traveler (Salem, MA)
- …through AHA required, *ACLS certification through AHA required, *Case Management, Utilization Management, and Discharge Planning skill set required, *Certified Case ... patients, *Collaboration with multidisciplinary teams to coordinate care and resource utilization , *Parking may not be validated and public parking may incur… 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 with CMS regulations and Commercial payors guidelines. Monitors and intervenes on LOS,… more
- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …judgment, and meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse, a sharp case manager, or a behavioral ... services. Discover more about us at www.amerihealthcaritas.com. Join a mission-driven Utilization Management team where your clinical expertise helps shape better… more
- Kaiser Permanente (Sacramento, CA)
- …Experience Minimum three (3) years of home care nursing experience or quality utilization review experience. Education Bachelors degree in nursing or related ... Job Summary: Coordinates quality, utilization and risk management activities for the Home...of important aspects of patient care through ongoing chart review with pre-established criteria. Reports all occurrences which may… more
- Boston Childrens Hospital (Boston, MA)
- Job Posting Description Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess for ... of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers,… more
- COMPREHENSIVE HEALTHCARE (Yakima, WA)
- …skills and working knowledge of insurance authorizations, levels of care, and utilization review . This is a non-clinical role that requires knowledge ... services. What are we looking for in a Clinical Review Specialist? The Clinical Review Specialist is...of care and modalities are being provided providing ongoing utilization management reviews for authorizing bodies in order to… more
- Molina Healthcare (Long Beach, CA)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Experience using PEGA Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- A-Line Staffing Solutions (Harrisburg, PA)
- …care, behavioral health, drug and alcohol treatment, managed care, quality management/ utilization review , or equivalent clinical experience. Knowledge of ... Job Description A-Line Staffing is now a motivated and detail- oriented Review and Elevation Registered Nurse In Harrisburg, PA Please contact Marcia Hamilton at ###… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- … review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services, payors, and community providers. Track and ... rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse (RN)… more
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