- Methodist Hospital Northeast (San Antonio, TX)
- Description Introduction Do you have the career opportunities as a(an) Nurse Manager of Critical Care ICU you want with your current employer? We have an exciting ... of colleagues. Do you want to work as a(an) Nurse Manager of Critical Care ICU where your passion...patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill… more
- Luminis Health (Annapolis, MD)
- …effective planning and communication with the OR Clinical Supervisor or Charge Nurse and the Surgical Staff Scheduler. Collaborate with Surgical Scheduler ... and the operative procedure occurs under conditions that maximize both patient and staff safety. The Cardiac Team Leader provides direct and indirect patient care… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Nurse issued by the State of Minnesota. **Title:** * Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* ... **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a* Staff Nurse *to join our Utilization ...may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse … more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to...new or revised procedures. + Works with Professional Standards Review Organization representative to orient new staff … more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... medical direction, administrative and technical supervision over the nursing staff engaged in utilization review ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... to infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of… more
- Huron Consulting Group (Chicago, IL)
- …located in Annapolis, MD + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the system, reporting to the ... Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the … more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion,...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… 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? ... Data gathering requires navigation through multiple system applications. + Staff may be required to contact the providers of...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue...level of care.. 5. Collaborates with case managers, nursing staff , coding team , the physicians and finance… 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 ... or recommendation. . Data gathering requires navigation through multiple system applications. . Staff may be required to contact the providers of record, vendors, or… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients. Registered Nurse (RN) required. Licensed Clinical Social… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review...within the last four (4) years as a registered nurse in utilization management. + One (1)… 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 Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Prime Healthcare (Ontario, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236094/ utilization - review - nurse ... productivity of UR Coordinators and Referral Technicians. Provides training to new staff on system and referral processes. Assists physician offices and vendors with… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Per Diem Advanced Practice Nurse (APN) or Physician Assistant (PA) for the Transition Utilzation Review Team utilizes a patient-centered coordinated care ... nursing program. 2. Master's or Doctorate degree from an accredited Nurse Practitioner program. 3. Maintains clinical competencies through continuing education and… more
- Hartford HealthCare (Willimantic, CT)
- …clinical nursing required. * Two years experience with case management, discharge planning, utilization review and/or home care required. * Knowledge of the ... is*your moment.* **Job:** **Nursing* **Organization:** **Windham Hospital* **Title:** *Registered Nurse Case Manager (RN) - Utilization Management* **Location:**… more
- Sanford Health (Rapid City, SD)
- …Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven ... terms of provision of service and providing direct supervision of all departmental staff . Maintains a standardization of utilization management process to ensure… more
- Dartmouth Health (Lebanon, NH)
- …care (LOC) determinations. * Works with individual physicians and office staff when they are experiencing discrepancies with pre-certifications. * Assumes ... Plan, etc. * Develops and implements communication strategies to keep clinicians and staff informed of changes and current practice. * Works closely with others to… more
