- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in ... holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties in providing care to… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Community Health Systems (Franklin, TN)
- …nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse ... appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for… more
- Centene Corporation (Cheyenne, WY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. + Knowledge of ABA services and BH utilization review process preferred. + Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Molina Healthcare (Bothell, WA)
- …candidate with a WA state LPN licensure. Candidates with case management, Utilization Management (UM), and direct managed care experience are highly preferred. ... individual State Plan. **JOB QUALIFICATIONS** **Required Education** Any of the following: Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)… more
- Ascension Health (Nashville, TN)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Ascension Health (Wamego, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and ... criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse or Licensed Practical Nurse with a current New York State license required. +… 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. + ... leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care...Licensure and/or Compact State Licensure or + LCSW - Licensed Medical Social Worker - State Licensure 180-days of… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/189323/case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3.… more
- Dartmouth Health (Lebanon, NH)
- Overview Utilization Review (RN) - Remote Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures ... leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote *… more
- Centene Corporation (Tallahassee, FL)
- …in the State of Florida **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- UNC Health Care (Raleigh, NC)
- **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review for Surgical admissions** Become part of an inclusive ... episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Dignity Health (Stockton, CA)
- …excellent care. St. Josephs Behavioral Health Center is a licensed not-for-profit facility providing comprehensive behavioral health services for psychiatric ... Our specially trained staff of board certified psychiatrists physicians and licensed professionals are committed to providing compassionate quality care and creating… more
- Crouse Hospital (Syracuse, NY)
- …while maintaining the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent and continued stay ... programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage...of Science degree in Nursing preferred. + For RNs licensed in or after 2017, completion of a Bachelor's… more
- Helio Health Inc. (Syracuse, NY)
- …preferred. + Licensed /credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: * Uses approved criteria and conducts ... the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review … more
- CVS Health (Frankfort, KY)
- …personal, convenient and affordable. **Position Summary** This is a fully remote Utilization Review Clinical Consultant. **MUST RESIDE IN KENTUCKY** + Utilizes ... + Must reside in state of Kentucky **Preferred** **Qualifications:** + Managed care/ utilization review experience preferred + Experience in a behavioral health… more
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