- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Primary Responsibilities * Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... in collaboration with an interdisciplinary team, the UMN manages complex cases and contributes to internal process development. This...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Review NurseJob Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to perform ... in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse ...practice in providing care to clients with basic or complex . An ADN or Diploma in Nursing AND 1 ... the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle...improvements in patient care through systematic evaluation and analytical review of clinical information. Responsibilities Responsibilities of the RUR… more
- AmeriHealth Caritas (Newark, DE)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional...ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION … more
- Ascension Health (Wichita, KS)
- **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs, Day shift, 7:30 AM- 4:00 PM, Monday-Friday, rotating weekends possible + ... Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... for approval or denial decisions + Identify and escalate complex cases requiring physician review or additional...ability to meet productivity standards in a fast-paced, high-volume utilization review environment The range displayed in… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …is seeking to hire experienced Registered Nurses to work in our Utilization Management (UM) Program. Incumbents are expected to perform assessing, planning, ... care coordinator, pertaining to patient flow. Responsible for focused studies of utilization patterns for the facility. Responsibilities Job duties include, but are… more
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... We are looking for a Utilization Management RN, to join us in leading...services. Collaborates with Medical Director and senior management on complex cases and special projects. **This position is hybrid… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... individual situation or the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the UR Medical… more
- Ascension Health (Milwaukee, WI)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Children's Hospital Boston (Boston, MA)
- …Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per ... Posting Description:Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess… more
- Community Health Systems (Birmingham, AL)
- …to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams (IDT) to ... with patients, families, and interdisciplinary teams. + Ability to assess complex situations, identify solutions, and implement care plans efficiently. + Proficiency… more
- UNC Health Care (Raleigh, NC)
- …the collective expertise and resources of UNC Health._ _We are currently seeking an experienced nurse to join our dynamic team as an RN Utilization Manager. Role ... episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Centene Corporation (Jefferson City, MO)
- …adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to… more
- Centene Corporation (Tallahassee, FL)
- …this leadership role, you'll provide guidance and oversight to a team of Utilization Review Clinicians focused on behavioral health prior authorizations.** **If ... you have experience in managed care, behavioral health utilization review , and leadership, we want to...performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH… more