- 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 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… 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...documented in the case management system by the UR Review Specialist . + In the event a… more
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... years of start date. + Current licensure as Registered Nurse in the State of Michigan. + Minimum of...+ Minimum of three years clinical experience required. Previous utilization review and/or case management in a… more
- Trinity Health (Maywood, IL)
- …Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist ** nurse works with the multidisciplinary team ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...Education: Holds a current Texas license as a Registered Nurse . Training and Experience: Three years clinical nursing experience… more
- Mount Sinai Health System (New York, NY)
- …Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The Utilization Review Specialist coordinates scheduling of all surgical/endoscopic ... **Job Description** ** Utilization Review Admission Specialist ...and operating room procedures. Seeks the assistance of the Nurse Manager in identifying cases, which require pre admission… more
- Alameda Health System (Oakland, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... System Utilization Management Specialist + Oakland, CA...staff. 8. Per the direction and delegation of the Utilization Management social worker and/or nurse , facilitates,… more
- Beth Israel Lahey Health (Milton, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. Qualifications: Required . Licensure as a Registered Nurse (RN), Massachusetts . Three years of recent clinical… more
- Vanderbilt University Medical Center (Nashville, TN)
- …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary ... difficulty. * Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business… more
- Penn State Health (Hershey, PA)
- …and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - DAY SHIFT - Utilization ... at ###@pennstatehealth.psu.edu (MAILTO://###@pennstatehealth.psu.edu) **SUMMARY OF POSITION:** Responsible for the review of clinical documentation in the Electronic Medical Record… more
- Katmai (Usaf Academy, CO)
- …for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Sutter Health (Sacramento, CA)
- …& LICENSURE:** + RN-Registered Nurse of California OR CNS-Clinical Nurse Specialist + BLS-Basic Life Support Healthcare Provider OR ACLS-Advanced ... Support OR PALS-Pediatric Advanced Life Support OR CNOR-Certified Perioperative Nurse OR NRP-Neonatal Resuscitation Provider **EXPERIENE AS TYPICALLY ACQUIRED IN:**… more
- Ascension Health (Baltimore, MD)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- BayCare Health System (Clearwater, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + ... Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands ... utilization review and coverage guidelines for multiple payers; + Identifies...and reviews findings with all levels of Payment Resolution Specialist for further review . Serve as a… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - F/C - 67056731 APD/ DDDP CHATTAHOOCHEE, FL Date: Jan 11, 2025 The State Personnel System is an E-Verify employer. For more ... Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - F/C - 67056731 APD/...as a member of the DDDP Behavior Analysis Local Review Committee, Support Planning Committee, and treatment team. Performs… more
- MyFlorida (Gainesville, FL)
- REGISTERED NURSE SPECIALIST -F/C OPS - 60957257 Date: Jan 28, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 843860 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C OPS - 60957257 Pay Plan: Temp Position Number:… more
- Sanford Health (Sioux Falls, SD)
- …and execute authorizations. Essential functions must occur simultaneously; therefore, the specialist must be able to appropriately handle and prioritize various ... and members in regards to authorization and/or denial of services. Ability to review , analyze and summarize reports and have effective oral and written communication… more
- Ochsner Health (New Orleans, LA)
- …in the delivery of patient care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care environment or ... License Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review , Utilization Management or Health Care Management… more