- 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 ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
- US Tech Solutions (Chicago, IL)
- …MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION ... with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- US Tech Solutions (May, OK)
- …MANAGED CARE exp and Medicare /Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… more
- Catholic Health Initiatives (Little Rock, AR)
- **Overview** As a Utilization Review nurse with CHI St Vincent Hot Springs, you'll work with physicians, other registered nurses, specialized departments, ... stay. + Abstracts data from records and maintains statistics. + Monitors and tracts Medicare denials, works with medical records to review third party payor… 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
- New York State Civil Service (Bronx, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), NYC Children's Center, Bronx Campus, P25875 Occupational Category… more
- Molina Healthcare (Long Beach, CA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- CareFirst (Baltimore, MD)
- …detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services. ... Upon Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. + ... Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships,… more
- Medical Mutual of Ohio (OH)
- …**Under general supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives and reviews ... environment.** **Technical Skills and Knowledge** + Knowledge of medical terminology, utilization review processes and awareness of health insurance benefits… more
- ERP International (Nellis AFB, NV)
- …the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the appropriate ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
- Stanford Health Care (Palo Alto, CA)
- …records to ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization reviews, applying evidence-based ... remote Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will...utilization management principles. + Experience in case management, utilization review , or related healthcare roles. +… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- HCA Healthcare (Campbell, CA)
- …years of experience in Managed Care, Provider Office, or Utilization Review organization required Physician Services Group ... We want your knowledge and expertise! **Job Summary and Qualifications** The ** Utilization Management Nurse ** 's primary function is to ensure timely… more
- Humana (Columbus, OH)
- …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical Appeals & ... Management, Case Management, Claims, Quality Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality… more
- Centene Corporation (Reno, NV)
- …including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management ... some of the following: post-acute care knowledge (SNF, LTACH, Rehab), utilization management (UM) experience, InterQual knowledge, or discharge planning knowledge.… more
- Sanford Health (ND)
- …28.00 **Department Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission… more
- Centene Corporation (Raleigh, NC)
- …requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more