- Northeast Georgia Health System, Inc (Gainesville, GA)
- …team members as needed to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning...patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted in a foundation of improving the health of our ... at all campuses operated by NGHS. Collaborates with the physicians, patients, families, nursing, utilization review and other members of the health care team to… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the ... appropriate feedback is received before product decisions are made. Utilization Review of necessity, quality, effectiveness and...to facilitate most effective par levels in based on clinical knowledge and process review . Demonstrates a… more
- GHR Healthcare (Atlanta, GA)
- …area (PA,NJ) Pay Rate: 37.50 -40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient ... Are you a detail-oriented RN with a knack for navigating complex medical...Collaborate with healthcare providers to clarify and obtain additional clinical information. Decision-Making: Authorize medically necessary services and refer… more
- Pacer Staffing (Atlanta, GA)
- …Provides Disease Management (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and evaluate the ... to successfully manage their chronic condition. . The DM nurse will partner with the interdisciplinary care team to.... Direct Education & Experience Required . Current, unrestricted RN licensure to independently work within scope of practice… more
- Pacer Staffing (Atlanta, GA)
- …processes and techniques for measuring outcomes. Education & Experience Required: . Registered Nurse , with current unrestricted license in appropriate state . ... Job Title: Clinical Ops and Policy Clinical Location:...Preferred: . TRICARE experience . Qualified for Certified Professional Utilization Review Certification or Certified Professional … more
- Pacer Staffing (Atlanta, GA)
- …other duties as assigned. Regular and reliable attendance is required. Required: Registered Nurse , with current unrestricted license in appropriate state 4+ ... criteria required. Preferred: TRICARE experience Qualified for Certified Professional Utilization Review Certification or Certified Professional Utilization… more
- Northeast Georgia Health System, Inc (Braselton, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the ... conflicts as they occur. With support from Charge Nurses and Educators, the Nurse Manager directly supervises the clinical nursing and ancillary nursing… more
- Engage Partners, Inc. (Orange, CA)
- …culturally competent services. Ensure charts meet quality management standards per monthly utilization review and/or chart review process, including ... substance abuse staff and others Education and Knowledge, Skills and Abilities Required: Registered Nurse , currently licensed in the State of California with a… more
- Equiliem (Orange, CA)
- …of experience providing ABA and or mental health services, including experience in clinical review and treatment plan oversight. An equivalent combination of ... position such as those listed above may also be qualifying.Preferred Prior authorization/ utilization review experience. Managed care experience. Post degree ABA… more
- US Tech Solutions, Inc. (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. . May provide any of ... sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that...individual patient's benefits contract and our medical policies. The nurse would read through clinical information, ensuring… more
- Pacer Staffing (Atlanta, GA)
- …licensure in an appropriate state or territory of the United States, as a Licensed Clinical Social Worker or Registered Nurse US Citizenship Must be able ... or other services as clinically appropriate and according to TRICARE policy. Conducts clinical review for requested services particular to the ECHO according to… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …as an RN in Georgia. National Certification in either a clinical or leadership specialty within two years of hire. Educational Requirements: Bachelors Degree ... Job Category: Clinical Support Work Shift/Schedule:12 Hr Evening - MorningNortheast...our communities. About the Role:Job SummaryResponsible for the systematic review of patient throughput including evaluating and implementing strategies… more
- Accounting Now (Carson City, NV)
- …or written review Will use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality ... member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are...provide an equivalent backgroundCurrent active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by… more
- Staffing Now (Carson City, NV)
- …or written review . Will use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality ... member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are...an equivalent background. Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by… more
- The Arora Group (Bethesda, MD)
- …+ The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse ( RN ) and pre-certification clerk. + The ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently...+ Experience: Requires a minimum of 2 years of clinical and utilization review experience… more
- Elevance Health (Tampa, FL)
- …Requirements:** + Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 3 years of managed ... unrestricted license or certification as a LPN, LVN, or RN practice as a health professional within the scope...Florida. + Minimum of 2 years of Long-Term Care clinical or Long-Term Care utilization review… more
- Prime Healthcare (Ontario, CA)
- …Administration, or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health ... Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... Licensure Upon Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred… more
- Billings Clinic (Billings, MT)
- …to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN . This...and Certification Healthcare Provider and ACLS CPR certifications Current Registered Nurse license in the state of… more
