- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily,… more
- Integra Partners (Troy, MI)
- …operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but are not… more
- Integra Partners (Troy, MI)
- …in a process-driven environment and are committed to consistency, compliance, and evidence- based decision making. The Utilization Review Medical Director ... The Utilization Review Medical Director is responsible...accuracy + Ability to work effectively in a high-volume, queue- based workflow with daily review expectations +… more
- Albany Medical Center (Albany, NY)
- …and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family ... of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient… more
- Providence (Polson, MT)
- **Description** **Care Manager RN - Utilization Review at St Patrick Hospital-Broadway Bldg-Missoula MT** **Schedule: Part Time, Variable Shift working between ... License + 1 year experience in care management or utilization review in any setting or +...the wage range for this position will be determined based upon relevant job experience and other applicable factors.… more
- BayCare Health System (Clearwater, FL)
- …This position ensures that the necessary information is gathered for timely and accurate utilization review and that requests for care or services are processed ... the Tampa Bay area. Our network consists of 16 community- based hospitals, a long-term acute care facility, home...records for each referral or authorization case. + Assist Utilization Review Nurses or Specialists with follow-up… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... the Tampa Bay area. Our network consists of 16 community- based hospitals, a long-term acute care facility, home...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management ... + Bachelor's Degree Or Associate's Degree in Nursing + 3 years of Utilization Review , Care Management, Quality Management, and/or Discharge planning **Why Join… more
- BayCare Health System (St. Petersburg, FL)
- …trust, dignity, respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + Directing and coordinating the ... + Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Team Lead **Location** St Petersburg:St Anthonys |… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Centene Corporation (Austin, TX)
- …assess ABA Treatment Plans required. **Knowledge of ABA services and BH utilization review process required.** Experience working with providers and healthcare ... flexibility. **2 POSITIONS AVAILABLE.** **THESE POSITIONS ARE REMOTE/WORK FROM HOME SUPPORTING CHILDREN AND ADOLECENTS ABA BEHAVIORAL HEALTH.** **ABA EXPERIENCE… more
- LifeCenter Northwest (Bellevue, WA)
- …actions. + Contribute to LifeCenter Northwest's strategic planning efforts and the Organ Utilization Team's operational plan. + Based on quality reviews of ... Type Full Time Description and Qualifications The Manager, Organ Utilization (OUM) provides strategic leadership and operational oversight for...+ Work is normally performed in an office or home - based office setting, as well as other… more
- Commonwealth Care Alliance (Boston, MA)
- …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... criteria + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency in MS Office to include… more
- CVS Health (Phoenix, AZ)
- …treatment, evidence based care and medical necessity criteria for appropriate utilization of services. + Consults and lends expertise to other internal and ... + Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes +… more
- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Humana's offices for training or meetings may be required. **Work-At- Home Requirements** + Must have the ability to provide… more
- University of Michigan (Ann Arbor, MI)
- Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals ... compliance with CMS regulations and third party payer requirements. They appeal based on medical necessity, level of care, administrative and outpatient denials.… more
- Actalent (Minnetonka, MN)
- …to assess the medical necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review . + Experience in acute ... Utilization Management Nurse Job Description As a ...inpatient rehabilitation, and long-term acute care hospitals. Responsibilities + Review and document prior authorization and concurrent stay requests.… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination...expected to work a portion of their week from home and a portion of their week at a… more