- Emory Healthcare/Emory University (Atlanta, GA)
- …development, and leadership programs + And more **Description** We're seeking an **Assistant Manager , Utilization Review ** , responsible for supervising and ... coordinating activities of personnel in the Utilization Review Department, including: + Staff schedules to ensure appropriate department coverage, equitable… more
- Trinity Health (Mason City, IA)
- …**Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, ... in the state of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized in the state of Iowa preferred… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre\-certifications and appeals, ... treatment driven, look back periods, rider information and medical policy/medical review criteria + Weekend/Holiday Shifts Required\. + Saturday and Sunday and… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/171837/case- manager %2c-rn utilization - review ... effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… more
- Prime Healthcare (Lynwood, CA)
- …licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/157925/case- manager -rn%2c-- utilization - review ... effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… more
- SUNY Upstate Medical University (Syracuse, NY)
- …of Mental Health regulations. Monitor open encounters and report any issues to the Business Manager . Review utilization of services in order to comply with ... Job Summary: The Utilization Review Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures paperwork is completed in a… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Manager Care Mgt & Util Review **Employment...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- Trinity Health (Syracuse, NY)
- …Day Shift **Description:** Abiding by the St. Joseph's Health Mission and Values, the manager of Utilization Review is responsible for the planning, and ... coordination of utilization review to promote appropriate, effective and...the patients within their service area. The Registered Nurse Manager is accountable for applying positive managerial strategies to… more
- Cedars-Sinai (Los Angeles, CA)
- …named us one of America's Best Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's placement to be at ... follows the UR process as defined in the Utilization Review Plan in accordance with the...continued employment. **Req ID** : 4300 **Working Title** : Utilization Management Case Manager - 8 Hour… more
- Lowe's (Charlotte, NC)
- …years of experience in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in ... **Your Impact** The Care Manager is a telephonic medical case management position...license in home State + CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse +… more
- Henry Ford Health System (Detroit, MI)
- …equipment. + Innovative Team Structure: Benefit from our new dyad Social Work/RN Case Manager model and remote utilization review setup, allowing you to ... and dynamic environment? Join our team as a Registered Nurse (RN) Case Manager ! Who We're Looking For: Passionate, compassionate, and dedicated individuals who are… more
- Hartford HealthCare (Torrington, CT)
- …*your moment*. **Job:** **Professional Clinical* **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager ... Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively...activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...Priority 5: Escalation Refers cases that require second level review to Physician Advisor, Manager , and Director… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting ... planners regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed review … more
- University of Miami (Miami, FL)
- …System, Department of Utilization Management, has an exciting opportunity for an Utilization Review Case Manager to work remote. The incumbent conducts ... retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for… more
- UNC Health Care (Hillsborough, NC)
- **Description** RN Utilization Manager is responsible for clinical reviews for medical necessity for both admission and continuing stay patients during the day ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...+ Preferred ACM (Case Management) + Preferred CCM (Case Manager ) **Education:** + Required Associates in Nursing or +… more
- AdventHealth (Altamonte Springs, FL)
- …. Develops and implements case management programs and education, including utilization review , transitions of care, disease management, population health ... **Senior Manager of Utilization ** **-AdventHealth Well65** **All the benefits and perks you need for you and your family:** . Benefits from Day One . Paid Days… more