- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …discharge. + Provides after hour safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for ... to meet the healthcare needs of the patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and Case Management. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...staffs. -Case Manager experience as well as Utilization Review experience ( review medical… more
- The Cigna Group (Sacramento, CA)
- …for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of ... Knowledge of managed care preferred. + Works independently, receiving direction from manager or team leader for new or unprecedented situations. + Manages own… more
- Elevance Health (Chicago, IL)
- **Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in person training sessions, ... and ensures essential face-to-face onboarding and skill development. The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network… more
- Elevance Health (Grand Prairie, TX)
- **Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... and ensures essential face-to-face onboarding and skill development. The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network… more
- Elevance Health (San Juan, PR)
- …information technology and business operations services for health plans._ **Nurse Reviewer I** **Location:** This role requires associates to be in-office 1 ... Friday but must be flexible according to business needs. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness… more
- UNC Health Care (Raleigh, NC)
- **Description** _Rex Holly Springs Hospital is proud to be a part of...nurse to join our dynamic team as an RN Utilization Manager . Role is full time, 40 ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... the first two years of employment. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Office/Site… more
- Dignity Health (Carmichael, CA)
- …discharge for appropriate status determination. + Ensures compliance with principles of utilization review , hospital policies and external regulatory ... **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite...collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... We Are:** At **Beth Israel Deaconess Hospital -Plymouth** , our patients always come first. We are...and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager… more
- Houston Methodist (The Woodlands, TX)
- …options to assure maximum benefits for patients and reimbursement for the hospital . + Applies approved utilization criteria to monitor appropriateness of ... At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN)...Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures.… more
- Tenet Healthcare (Detroit, MI)
- …experience in hospital revenue cycle function. Five (5) years in hospital Utilization Review Leadership preferred. Multi-site leadership experience ... preferred. Experience successfully implementing centralized Utilization Review teams for multi- hospital ...skills including ability to use PowerPoint. · Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six… more
- Scottish Rite for Children (Dallas, TX)
- …their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital Additional Posting Details: Monday - ... and other areas as assigned + Serve on the Utilization Review Committee for the Scottish +...Minimum 2 years of precertification experience + Certified Case Manager , preferred + 3-5 years of clinical experience, preferably… more
- Houston Methodist (Houston, TX)
- …+ Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed Care ... At Houston Methodist, the Utilization Review Nurse (URN) position is...prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as… more
- Alameda Health System (Oakland, CA)
- … Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Evening + Nursing + Req ... FTE:1 + Posted:May 22, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review ...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
- Baptist Memorial (Meridian, MS)
- …RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer setting Education ... Overview RN Utilization Review Weekender Job Code: 22818...hire, terminate, discipline, promote or effectively recommend such to manager . Reporting Relationships: No Work Environment Functional Demands Label… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Duties & Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the appropriate admission… more
- Providence (Mission Hills, CA)
- **Description** RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home ... experience working in a remote UR environment or working as an acute hospital case manager . **Preferred qualifications:** + Bachelor's Degree Or Master's Degree… more
- HCA Healthcare (Richmond, VA)
- …an organization that invests in you as a(an) Case Manager Behavioral Utilization Management? At Chippenham Hospital , you come first. HCA Healthcare has ... members over the course of three years. **Benefits** Chippenham Hospital , offers a total rewards package that supports the...a difference. We are looking for a dedicated Case Manager Behavioral Utilization Management like you to… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital , health care, or managed ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more