- 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 ... reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison...Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent… more
- 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
- SR International, Inc. (Phoenix, AZ)
- …obtain their own laptop SOAZ - Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote/Onsite Trainings) Skills Required: *Medical nursing practice, ... medical case management protocols, quality management and utilization review protocols as related to all populations including Maternal and Child Health… more
- University Health (San Antonio, TX)
- …Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration with the...licensure as a Registered Nurse with the Texas State Board of … more
- PharmaCord (Jeffersonville, IN)
- …healthcare industry is required Bachelor's degree required; Master's degree is preferred Nurse line triage, Call Center Utilization Management, Call Center Case ... report it to our Talent Acquisition team immediately at ###@pharmacord.com The Nurse Program Manager plays a pivotal role in optimizing the operational performance… 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 ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration with the...Current licensure as a Registered Nurse with the Texas State Board of … more
- Fresenius Medical Care (Cadiz, KY)
- …auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials ... including efficient utilization of supplies or equipment and regular profits and loss review . Responsible for all required network reporting and on-site state or… more
- Fresenius Medical Care (Waukegan, IL)
- …all FMS manuals. Accountable for completion of the Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper or voice mail, ... required supporting billing and collection activities. Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… 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 ... Nurse , Care Management + San Leandro, CA + San...experience in Case Management in an acute setting or utilization review at a medical group or health… more
- Stony Brook University (Stony Brook, NY)
- Registered Nurse 1 (T&RC) - Blood Donor Full-Time Day Shift **Position Summary** At Stony Brook Medicine, our Registered Nurses are critical members of the team who ... adhering to a medical regimen. **Duties of a Registered Nurse in the Blood Donor Department may include the...Donor and Therapeutic Apheresis as assigned.. + Perform blood utilization quality assurance, donor related work as assigned. +… 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 ... $7500 Sign-On Bonus Position Overview: The Hospice Registered Nurse is responsible for pain management, symptom control in the delivery of care to hospice patients,… 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 ... Specialty Case Manager Job ID 33531206 Job Title Registered Nurse - Case Manager @ Providence Little Company of...Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day… more
- Aurora Mental Health & Recovery (Aurora, CO)
- …by telephone for face-to-face evaluation of emergency patients, as appropriate. Provide utilization review of all patients in continuing care to ensure ... care for psychiatric conditions. We are hiring a part-time Nurse Practitioner (20 hours per week) who enjoys providing...honoring and respecting all persons. The AMHR Psychiatric Access Nurse Practitioner works together with a team of other… more
- Katmai (Fort Carson, CO)
- …same duties as those required of any military or government civil service nurse of similar experience and in similar duty assignments. **ESSENTIAL DUTIES & ... all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. Adhere… more
- Luke Staffing (Glendale, CO)
- **REGISTERED NURSE ** **SITE OF SERVICE:** Department of Veterans Affairs, Eastern Colorado Healthcare System (ECHCS), 4100 E. Mississippi Ave, Glendale, CO 80246 ... AM - 5:30 PM (excluding federal holidays) **POSITION OVERVIEW:** The Registered Nurse (RN) will provide on-site professional nursing services to beneficiaries of the… 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
- ERP International (Camp Lejeune, NC)
- …providers for 90% of all referrals. + Provides timely, descriptive feedback regarding utilization review issues. + Reviews and enters first right of refusal ... hospital procedures and regulations. Collaborates with TRICARE Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues or concerns. +… more
- Endeavor Health (Skokie, IL)
- …Degree Health Administration Required Or Bachelors Degree Nursing Required 3 Years Utilization review , discharge planning, case management or disease management ... is responsible for the case management, care coordination management, and utilization management of his/her population of patients across multiple care levels… 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
- Houston Methodist Hospital (Houston, TX)
- …while providing excellent customer/patient service. Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs… more
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