- LifePoint Health (Brentwood, TN)
- *System Director Utilization Review * *Who we are:* At Lifepoint Health, we provide quality healthcare to rural communities. As a valued member of our team, ... valid job field* **Organization:** **LifePoint Health Support Center* **Title:** *System Director of Utilization Review * **Location:** *Tennessee-Brentwood*… more
- University of Utah Health (South Salt Lake, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Ochsner Health (New Orleans, LA)
- …interpersonal and conflict resolution skills. **Job Duties** + Lead and directs Utilization Review (UR) staff and functions, including staffing, staff ... reviews to identify escalation issues regarding Providers, other facility issues, individual utilization review staff skills, payor-based concerns and to provide… more
- Community Health Systems (Naples, FL)
- …direction of the Utilization Review (UR) Director /Manager the Utilization Review (UR) Nurse reviews all admissions for medical necessity, correct ... Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Utilization Review experince preferred + Experience in HEDIS, MIPS, PQRS, ACO,… more
- Actalent (Nashville, TN)
- Actalent is Hiring a Team of Post Acute Utilization Review Nurses - Open to both RNs and LPNs! - Remote! This is a Monday to Friday 10am - 7pm CST (No weekends ... and Start Date of 3/24!! Job Description The PAC Nurse is a telephonic position responsible for recommending discharge... experience and/or discharge planning. + 2 years of utilization review /management experience. + 1 year of… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... the TN market. Must be located within TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role,… more
- Veterans Affairs, Veterans Health Administration (San Juan, PR)
- Summary The Utilization Management Nurse (UMN) serves as a subject matter expert in the clinical criteria at the facility level and conducts clinical reviews of ... and creative approaches to management of patient care. Responsibilities The Utilization Management Nurse (UMN) demonstrates expertise in the professional… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Katmai (Usaf Academy, CO)
- …Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,...licensed in Colorado, be able to practice using a nurse compact state license or have a license from… 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 ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Providence (Olympia, WA)
- …+ Previous healthcare administration and/or delivery of healthcare services + Utilization Management/ Review **Preferred Qualifications:** + Bachelor's Degree in ... **Description** The Supervisor for Utilization Management provides a key role in leading,...optimum outcomes. The UM Supervisor assists the Washington NWR Director of Care Management in support of programs by… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... functions for assigned sites. + Collaborate with the director to develop and implement quality review ...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
- Community Health Systems (Franklin, TN)
- …nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- RWJBarnabas Health (Newark, NJ)
- Registered Nurse (RN) Director of Patient Care Cardiac Cath Lab FT DaysReq #:0000180082 Category:Leadership Status:Full-Time Shift:Day Facility:Newark Beth ... Job Overview: RWJBarnabas Health is seeking a highly dedicated Director of Nursing for our Cardiac Cath Lab at...American Heart Association (AHA) + Active New Jersey Registered Nurse License or Multistate Compact License Scheduling Requirements: +… more
- LA Care Health Plan (Los Angeles, CA)
- …Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review . Collaborates with ... Utilization Management Admissions Liaison RN II Job Category:...specific to the case type. Identifies requests needing medical director review or input and presents for… more
- Banner Health (Mesa, AZ)
- …no better time than now to be a part of our team. As the **Associate Director of NICU** you will be leading a high-quality team with expertise in Neonatal Intensive ... drives high clinical outcomes, excellent experience, and effective resource utilization . The role actively participates in department and facility...operations of the unit and reports to the WIS Director of Nursing. As a member of our team,… more
- Independent Health (Buffalo, NY)
- …well as manage medical expenses based on trends. They will maintain UM review requirements, obtain reporting to understand utilization trends and cost, recommend ... and commitment to diversity and inclusion. **Overview** The Program Manager- Utilization Management (UM) will be accountable for the management, implementation,… more
- The Cigna Group (Denver, CO)
- …discharge/transfer to an alternate level of care. + Consults with manager and medical director to resolve any issues related to delay of services or barriers to ... impact. + Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit...to this role. **Minimum requirements:** + Active unrestricted Registered Nurse (RN) license in state or territory of the… more