- HealthCare Support (Houston, TX)
- Utilization Review RN HealthCare Support is actively seeking a Utilization Review RN to fill an opening with a Prestigious HealthCare Company in Remote ... Houston TX . Daily Responsibilities for Utilization Review RN: WIll need to use their OWN EQUIPMENT: 2 screens, will need a headset, high speed internet,… more
- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical… more
- SR International, Inc. (Phoenix, AZ)
- …*Medical nursing practice, medical case management protocols, quality management and utilization review protocols as related to all populations including ... pertaining to the AHCCCS program *Good written and communication skills *Computer skills * Utilization Review skills *Medical Claims Review skills *Producing… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... other interdisciplinary team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required Licenses/Certifications: Active… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Somatus (Mclean, VA)
- …+ Travel (up to 25%) to local renal care providers for quality oversight and utilization review collection + Other duties as assigned. _Please note this job ... and policies of Somatus + Assist Directors of Quality on quality and utilization audits as assigned, including targeted audits as requested by the Director. +… more
- University Health (San Antonio, TX)
- …recent, full time hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- COOLSOFT (Raleigh, NC)
- …the Pharmacy Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral ... areas, including. o Clinical policies and Prior Authorizations. o Drug Utilization Review (DUR) and pharmacy lock-in related processes o Behavioral health, and… more
- Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
- …License Certifications: BLS - AHA Must-Have: Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates ... timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines. Onboarding… more
- Emanate Health (West Covina, CA)
- …for performing clinical consults according to pharmacy guidelines and conducting ongoing drug utilization review to promote effective, safe and efficient use of ... medications. Supervises technicians to optimize workflow and resource utilization . Actively participates in CQI activities. **Job Requirements** **Minimum Education… more
- Monte Nido (Eugene, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and aftercare… more
- Aveanna Healthcare (Birmingham, AL)
- …the plan of care and patient needs. Participates in quality improvement, utilization review , and infection control activities as requested. Attends appropriate ... documents such coordination. Collaborates with the interdisciplinary team in the development, review and revision of the clinical component of patient/family plan of… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... resource Management issues; other issues including concerns involving under/over utilization , avoidable days and quality issues. Coordinate daily with… more
- Jobleads-US (Baltimore, MD)
- …Drives renewal process and can lead client meetings regarding renewals and utilization review . Introduces new products and promotes them through regular ... factors including education, experience, skills, internal equity and market conditions. We review pay regularly to ensure competitive and equitable pay. We offer a… more
- University Health (San Antonio, TX)
- …(as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement. Current American Heart Association, Basic… more
- University Health (San Antonio, TX)
- …to five years nursing experience required. Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS ... Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred. Current American Heart Association, Basic Cardiac Life Support and/or Health Care… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …to perform discharge planning and utilize interqual criteria - Experience in utilization review and concurrent reviews Description: This position requires ... rotating weekend coverage. The candidate will manage a caseload of up to 15 patients on weekdays and a potentially higher number on weekends, depending on census. Responsibilities include care coordination, discharge planning, and ensuring medical necessity… more
- GCI Communication Corp (Anchorage, AK)
- …and utilization to meet business and operational needs. + Facilities Utilization & Performance: Regularly review network facilities utilization and ... the software and firmware upgrade/patch process, minimizing operational disruption. + Review and analyze the effectiveness of implemented network and service… more
- Cordis (Miami Lakes, FL)
- …capacity analyses, cost standards, and time studies to optimize efficiency and resource utilization . + Review and analyze key performance indicators (KPIs) to ... ensure short- and long-term goals are met; implement data-driven corrective actions to improve yields, efficiency, and on-time performance. + Schedule production builds and manage kanban inventories efficiently to meet daily, weekly, and monthly targets;… more
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