- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point ... this position is able to cover a multitude of utilization review functions through point of entry,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized ... 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Utilization Review Specialist **Cost Center:** 101651289 Revenue Cycle ... Shift:** 40 Normal (United States of America) **Job Description:** **JOB SUMMARY** The Utilization Review Specialist , Revenue Cycle Provide quality assurance… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Actalent (Sunrise, FL)
- …Health Utilization Review SpecialistJob Description The Behavioral Health Utilization Review Specialist conducts comprehensive utilization ... review with hospitals and mental health centers. The specialist is responsible for planning discharges and aftercare, and...LMHC). + Minimum of two years of experience in utilization review /case management. + At least one… more
- Nuvance Health (Danbury, CT)
- …Education: ASSOCIATE'S LVL DGRE Preferred : Two Years of Utilization Review experience Required : CT Registered Nurse License Working Conditions: Manual: ... 9am-930pm; including every 3rd weekend rotation Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary… more
- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...Registered Nurse (RN) Utilization Review Job Type: Full Time...of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records ... without reasonable accommodation to perform the following duties: + Complete chart review and communicate patient status medical needs with insurance companies in… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- Summary The Registered Nurse Peer Review QM Specialist at the Orlando VAMC primary responsibilities include performance improvement, ensuring compliance with ... management for Quality Management. Responsibilities The Peer Review Quality Management Specialist RN is a proficient nurse who understands a situation as… more
- New York State Civil Service (Albany, NY)
- …of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning.Substitution: a bachelor's degree in nursing ... HELP No Agency Corrections and Community Supervision, Department of Title Registered Nurse 3 - Utilization Temp/Hourly Occupational Category Health Care,… more
- Katmai (Fort Carson, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- LA Care Health Plan (Los Angeles, CA)
- Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department: Managed Long Term Services and Supports Location: Los Angeles, ... Job Summary The Managed Long-Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical...home care, palliative care, hospice care OR experience in Utilization Review or Care Management will be… more
- Ascension Health (Pensacola, FL)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... **Details** + **Department: Utilization Review ** + **Schedule: Full time...**Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Department of Health obtained… more
- Ochsner Health (New Orleans, LA)
- …in the delivery of patient care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care environment or ... License Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review , Utilization Management or Health Care Management… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry **Requisition Number:** CHAP-2270 **Cambridge Health Alliance (CHA)** , a well-respected,… more
- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days **Department** : CSRC CDI Services… more
- University of Virginia (Charlottesville, VA)
- Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management process. They collaborate with physicians and ... RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission vision… more
- Actalent (Columbus, OH)
- Authorization Specialist *REMOTE & MUST LIVE IN OHIO* INTERESTED...+ Utilization review + Clinical review + Patient care + Licensed registered nurse ... SETUP A PHONE INTERVIEW: 419. 980. 5823 Job Description The Authorization Specialist will perform medical necessity and clinical reviews of authorization requests in… more
- LA Care Health Plan (Los Angeles, CA)
- Medical Review Nurse Coder RN III (Payment Integrity Nurse ) Job Category: Clinical Department: Managed Care Services Location: Los Angeles, CA, US, 90017 ... and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The… more