- Ascension Health (Tulsa, OK)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... professional licensure at time of hire. **Additional Preferences** + Strong Utilization Review experience + Exceptional communication skills + Leadership… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal… 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
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Katmai (Usaf Academy, CO)
- …Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,...licensed in Colorado, be able to practice using a nurse compact state license or have a license from… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at identified review points and attend treatment ... caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse , and other members of the treatment team, ACCESS...a case by case basis. Applies case management and utilization review principles in monitoring the delivery… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the ... Director , is responsible and accountable for the operational management,...activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with… 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
- 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
- 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
- Sharp HealthCare (San Diego, CA)
- …or case management experience + 3 Years recent case management, utilization review , care coordination experience + California Registered Nurse (RN) - CA ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving… more
- BrightSpring Health Services (Canton, OH)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- Vanderbilt University Medical Center (Nashville, TN)
- …and capital expenditure budgets; and performing personnel administration functions. The Registered Nurse Director for the Digestive Disease Center will oversee ... Endoscopy Labs. Preferred Education, Skills, and Experiences: * Master's prepared Registered Nurse is essential * 5+ years of leadership experience in an ambulatory… more
- Evolent Health (Columbus, OH)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... review admissions and continued stay to determine appropriate Utilization , Quality Assurance, Risk Management and Discharge Planning Needs.2. Validates all… more
- BronxCare Health System (Bronx, NY)
- …in order to prepare a response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of denial reason and ... needed. - Participates in special projects and committees as determined by Director . Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a… more
- Commonwealth of Pennsylvania (PA)
- …I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or ... have professional experience performing this Work Behavior as a nurse administrator, nurse director , chief...Work Behavior as a charge nurse , head nurse , utilization review nurse… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience… more
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