- 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, or health plan ... readability scoring + Knowledge of the appeals process + Experience with audit preparation + Basic computer skills UCLA Health is a world-renowned health… more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This includes ... the VNS Health Plans teams on a day- to-day basis for utilization issues, problem resolution, complaint resolution and other service related issues. Manages… more
- Trinity Health (Columbus, OH)
- …Inpatient and Outpatient cases. + Analyze, summarize, and concisely report medical utilization and medical chart audit results. + Compare clinical information ... **Employment Type:** Part time **Shift:** **Description:** ** Utilization Review RN, Case Management** **Why Mount Carmel?**.../ Certification: Current license to practice as a Registered Nurse (RN) in the State of Ohio. + Experience:… more
- Corewell Health (Grand Rapids, MI)
- Job Summary Effectively leads and motivates the Utilization Management team to ensure the goals and standards of the department are being met. This position is ... to policies and procedures pertaining to data entry and audit activities. Ensures applicable policies and procedures are implemented...acute care or office setting + LIC - Registered Nurse (RN) from the State of Michigan upon hire… more
- McLaren Health Care (Bay City, MI)
- …6. Provides support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process are met, including ... sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and… more
- Molina Healthcare (Los Angeles, CA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more
- Johns Hopkins University (Lutherville, MD)
- The Department of Otolaryngology is seeking a **_CO_** **_Clinical Nurse Manager_** the Clinical Nurse Manager collaborates with the Medical Director and Clinic ... staff training/ education and development. In partnership with the Clinic Supervisor, the Nurse Manager provides oversight to the clinical staff (RNs/ CMAs) in three… more
- Elderwood (Hamburg, NY)
- Salary $38.00 - $48.50 / hour Overview Elderwood is seeking a Registered Nurse to join our clinical team as a RN MDS Nurse . LPNs, with the right skill set, will ... be considered as well. MDS Nurse - Position Overview: + An MDS ...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
- Northern Rivers Family Services (Queensbury, NY)
- …Team/Behavioral Health, cooperate with the County and participate in any quality audit and utilization review + Provide on-site/community based/home visits ... Nurse -Psychiatric NP Job Details Job Location Queensbury-Bay-PCFC -...$183,040.00 Salary Travel Percentage Up to 25% Job Category Nurse Job Posting Date(s) Start Date 09/24/2024 Description Signing… more
- Providence (Beaverton, OR)
- …team facilitation, data analysis and or case review + Experience working as a Nurse supporting a minimum of one HEDIS Audit season **Why Join Providence ... empower them._** **Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:** + Be responsible for...electronically or on site in physician practices during the audit season + Successfully complete HEDIS training prior to… more
- WellSpan Health (Lebanon, PA)
- Registered Nurse , Special Projects (Outpatient) - Ambulatory Clinical Support - South 4th Street Location: WellSpan Medical Group, Lebanon, PA Schedule: Full Time ... process- observation, supporting system objectives, patient outreach and chart review/ audit , Review of literature to support evidence based practice across… more
- Fresenius Medical Center (Ogden, UT)
- …fosters a commitment to patient satisfaction and teamwork. Supervision of Nurse Practitioners and Physician Assistants (Advanced Practitioners ), training and clear ... program and Federal and State regulations pertaining to quality and utilization management. + Familiarity with evidence-based practice and KDIGO/KDOQI best practice… more
- Symetria Recovery (Chicago, IL)
- …in the context of Evaluation/Management visits when appropriate. + Utilization of safe prescribing practices and evidence-based treatment guidelines for ... co-occurring substance use disorders. + Complete training provided on utilization and result interpretation of available diagnostic procedures (Ie Pharmacogenetic… more
- CommuniCare Health Services Corporate (Akron, OH)
- …and targets for utilization + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization , ... Registered Nurse (RN), Mobile MDS Coordinator CommuniCare Health Services is currently looking for a Registered Nurse to fill the key position of RN Mobile MDS… more
- Banner Health (Phoenix, AZ)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... facilities in the Phoenix Metro area. Exemplars mentioned from the American Nurse Credentialing Center included the robust nursing succession planning and the… more
- HCA Healthcare (Nashville, TN)
- …environment where diversity and inclusion thrive? Submit your application for our Research Nurse opening with HCA Healthcare today and find out what it truly means ... may vary by location._** We are seeking a Research Nurse for our team to ensure that we continue...informed consent forms, source documentation, drug dispensing logs, device utilization logs, subject logs and study-related communications + Tracks… more
- Wellpath (Dublin, CA)
- …training, education, and point of care support. **How you make a difference** The Nurse Practitioner provides a full range of medical services for inmates. They work ... and procedures for infirmary admissions, emergency room transfers, and the utilization review process for specialty referrals while maintaining responsibility for… more
- Banner Health (Sterling, CO)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Banner Health (Tucson, AZ)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more