- Community Health Plan of Washington (Eugene, OR)
- …organization. * Create an equitable work environment. About the Role The Level I Utilization Management Clinician performs utilization review for medical or ... behavioral health requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements...do not meet medical necessity or criteria for medical director review . * Communicate effectively with medical… more
- Saint Francis Health System (Tulsa, OK)
- Saint Francis Health System is seeking a Registered Nurse (RN) Virtual Care for a nursing job in Tulsa, Oklahoma.Job Description & RequirementsSpecialty: Virtual ... click HERE to login and apply.Full Time7p - 7aVirtual Nurse works from an on-site office location (not a...location (not a remote position)Will perform admit, discharge chart review and other patient care duties from an office… more
- Saint Francis Health System (Tulsa, OK)
- Saint Francis Health System is seeking a Registered Nurse (RN) Endoscopy for a nursing job in Tulsa, Oklahoma.Job Description & RequirementsSpecialty: ... 6:30 AM - 5:00 PMMinimal call required.#RNSINDJob Summary: The Clinical Nurse I assesses, plans, implements and evaluates nursing care, utilizing the… more
- Pathways Vermont (Burlington, VT)
- …Registered Nurse (APRN). Meet weekly for individual supervision, to review role expectations and provide feedbackProvide ongoing support for job completion ... Soteria House Program Manager Supervisor: Alternative Mental Health Services Director Location: Burlington, Vermont Responsibilities:Oversight of Service ProvisionEnsure excellent… 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 the Utilization ... requiring clinical review prior to payment. The Utilization Review Nurse will use...requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a team responsible ... 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …+ Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This position… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- Actalent (Kansas City, KS)
- Job Title: Utilization Review - Post Acute Care Job Description Our PAC Nurse is a telephonic role responsible for recommending discharge plans, assisting ... for their assigned and non-assigned post-acute care (PAC) facilities. The PAC Nurse will collaborate with key facility personnel and internal Medical Directors,… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …performance and facilitates educational training for medical staff on issues related to utilization management. 1. Implements utilization review policies and ... coaching, mentoring, training and development. Educates and trains staff on utilization review processes and guidelines. 3. Promotes collaborative practice… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews… 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 will facilitate, coordinate, and approve… 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
- Molina Healthcare (CA)
- This is a fully remote role. The Director of Healthcare Services position will be overseeing the Outpatient Utilization Management Team. Candidates must have an ... following key Healthcare Services functions: case management/disease management/care transitions; utilization management (Position oversees PA authorizations and manages the… more
- Immigration and Customs Enforcement (IN)
- … Director for Healthcare Compliance, Office of Health Plan Management. The Senior Utilization Review Consultant will report directly to the IHSC Regional ... DUTIES AND RESPONSIBILITIES: Serves in the capacity of Senior Utilization Review Consultant and subject matter expert...preferred. Meet the minimum education requirements for either a nurse , nurse practitioner, or physician assistant … more
- Ascension Health (Baltimore, MD)
- …initiatives. + Develops systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... CM as appropriate * Performs other duties as assigned Utilization Management: + Ensures integration of utilization ...Heart Association or American Red Cross accepted. + Registered Nurse obtained prior to hire date or job transfer… 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
- Billings Clinic (Billings, MT)
- …(https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN - Utilization Review (Full-time/Billings) CARE MANAGEMENT ... loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This position is...UM representatives on denials and coordinate peer to peer review with payer's medical director *Initiates and… more
- Trinity Health (Syracuse, NY)
- …Currently offer 10,000 sign-on retention bonus for qualified experienced RN's. The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) ... actively manages the utilization review process and patient progression from...to all patients in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing… more
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