- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... manner and promotes the efficient and effective use of patient services. The Utilization Review Team's role in data collection, analysis and summarization… more
- UNC Health (Chapel Hill, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization … more
- Wilson Medical Center (Wilson, NC)
- …external delivery of healthcare services. The Case Manager integrates the roles of Utilization Management , Case Management , and Discharge Planning. The Case ... 7. The Case Manager independently performs clinical reviews based on the Utilization Review Plan with follow-up actions identified for medical necessity… more
- Glens Falls Hospital (Glens Falls, NY)
- …be foundhere. **Job:** **Nursing - Case Management * **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Humana (Richmond, VA)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review Post-Acute Preauth cases using ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Beth Israel Lahey Health (Burlington, MA)
- …Medical Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three ... Description:** **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization ... requiring clinical review prior to payment. The Utilization Review Nurse will use...nursing experience as a RN, with a focus of Utilization Management in a managed care environment.… 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** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Albany Medical Center (Albany, NY)
- …Management /Social Work Work Shift: Day (United States of America) Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. Salary: $65,062.40 - $107,348.80 * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to… more
- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in...position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Role BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Trinity Health (Fresno, CA)
- …Manager of Utilization Management will ensure the timely delivery of utilization review , discharge planning and support case management and the ... Type:** Full time **Shift:** **Description:** **Are you an experience RN Manager, Utilization Review of Acute Care seeking your next adventure?** **Duration:**… more
- Ascension Health (Minooka, IL)
- …additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning, and utilization review . + ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Universal Health Services (Temecula, CA)
- …Healthcare Regional office in Temecula, CA is seeking Two (2) LVN Full-Time Central Utilization Review Nurses who will be responsible for carrying out ... utilization management functions by planning, coordinating, and...source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
