- 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 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … more
- TEKsystems (Los Angeles, CA)
- …This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong ... provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with HMO/Medicare claims,… more
- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible...accommodation to perform the following duties:** + Complete chart review and communicate patient status medical needs with insurance… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + ... Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- University of Southern California (Los Angeles, CA)
- The Clinical Nurse Specialist serves as a resource/consultant for all departments regarding clinical specialty, conducts/ participates in research across varied ... for staff within the hospital and community. Facilitates the training of clinical nurse specialist students and other nursing students as necessary in… more
- Immigration and Customs Enforcement (Washington, DC)
- …with the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist , Medical Asset Support Team (MAST) member works under ... clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing… more
- State of Georgia (GA)
- …federal rules and regulations + Develops, implements, and evaluates the surveillance of utilization review process to ensure quality services + Monitors, tracks, ... Complnc Specialist 3 - Registered Nurse Georgia...facilities, regulated entity operations and program management + Conducts utilization reviews, peer reviews, evaluation activities and all other… more
- UPMC (Harrisburg, PA)
- …the most specialized and rewarding areas of pediatric medicine. Purpose: The Programmatic Nurse Specialist , a professional registered nurse , has the ... the nursing process. In collaboration with the health care team, the Programmatic Nurse Specialist applies expert clinical knowledge and skills to achieve… more
- Hospice of Michigan (Ann Arbor, MI)
- …work with minimal supervision. + Requires knowledge of quality assessment and utilization review functions, principles and practices. + Theoretical and practical ... personnel on the QAPI plan, and team development. + Performs clinical record review activities for data collection. + Compiles, analyzes, trends and reports quality… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... any other healthcare provider. We are seeking a(an) Assessment Specialist PRN to join our healthcare family. **Benefits** TriStar...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- Rush University Medical Center (Chicago, IL)
- …may vary depending on the circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of ... best practices, policies, strategic goals and RUSHICARE values. The Clinical Consulting Specialist role is a member of the nursing leadership team and demonstrates… more
- Sharp HealthCare (San Diego, CA)
- …(CPPS) - Certification Board for Professionals in Patient Safety; California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree **Hours** ... **What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams… more
- Carle Health (Champaign, IL)
- …patient care outcomes. The incumbent will have a deep understanding of utilization review and case management principles, case management best practices, ... experience 2+ years Responsibilities Maintain current knowledge of case management and utilization review trends including the entire continuum of care within… more
- HCA Healthcare (Largo, FL)
- …and personal growth, we encourage you to apply for our Clinical Rehab Specialist PRN opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the PRN career opportunities as a(an) Clinical Rehab Specialist PRN you want with your current employer? We have an exciting opportunity… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: RN Specialist Complex Case Manager Location: Remote Career Area: Health Services About Blue ... The Impact You Will Have Utilizing key principles of case management, the RN Specialist will research and analyze the member's health needs and health care cost… more
- System One (Baltimore, MD)
- …to providers for record retrieval, as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist Schedule: 8-hour shifts (start time ... Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224...care preferred) + Previous case management, discharge planning, or utilization review experience + EMR navigation experience… more
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