- 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 will facilitate, coordinate, and… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding ... and compassionate team. **The Utilization Review Specialist Senior responsibilities...Nursing RN. **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM… more
- BayCare Health System (Winter Haven, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + ... Critical Care or Emergency Service Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Winter… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- The Mount Sinai Health System (New York, NY)
- …Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The Utilization Review Specialist coordinates scheduling of all surgical/endoscopic ... ** Utilization Review Admission Specialist ...and operating room procedures. Seeks the assistance of the Nurse Manager in identifying cases, which require pre admission… more
- Cleveland Clinic (Stuart, FL)
- …nurses, and other caregivers in a family-oriented, supportive environment. As a PRN Utilization Management (UM) Specialist , you will perform UM activities, such ... as admission review , concurrent review , retrospective chart ...three years equivalent full-time clinical experience as a Registered Nurse . + Prior Utilization Management experience is… more
- Cleveland Clinic (Weston, FL)
- …Miami-Fort Lauderdale metro area and remains a top hospital in Florida. As a Utilization Management (UM) Specialist , you will work under the general supervision ... of the UM Team Manager to perform UM activities which include admission review , concurrent review , retrospective chart review and clinical systems review … more
- University of Washington (Seattle, WA)
- …partial/variable involvement with Harborview's Emergency Department. The Utilization Management Specialist RN2 is responsible for the ongoing review of a ... benefits for this position, click here (https://hr.uw.edu/benefits/wp-content/uploads/sites/3/2018/02/benefits-summary-classified-staff-greater-than-half-time-20220908\_a11y.pdf) . RN2, Utilization Management Specialist . This is a hybrid… more
- Sanford Health (Sioux Falls, SD)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- New York State Civil Service (Albany, NY)
- …years of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning. Substitution: a bachelor's degree in ... NY HELP Yes Agency Corrections and Community Supervision, Department of Title Registered Nurse 2 - Utilization (NY HELPS) Occupational Category Health Care,… more
- Katmai (Usaf Academy, CO)
- …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
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Accreditation and Quality (A&Q) Nurse Specialist demonstrates leadership in providing continuous readiness for accreditation and regulatory agency ... review and compliance (Joint Commission, Inspector General, Long Term...package: VA Nurse Total Rewards The A&Q Nurse Specialist reports directly Chief of Quality.… more
- Amergis (Newington, CT)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible...files for Centers for Medicare and Medicaid Services(CMS), external review organization (QIO or IRE). Work with Utilization… more
- MyFlorida (Macclenny, FL)
- REGISTERED NURSE SPECIALIST OPS - 60955422 Date: Jun 30, 2024 Location: MACCLENNY, FL, US, 32063 The State Personnel System is an E-Verify employer. For more ... . Requisition No: 772103 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST OPS - 60955422 Position Number: 60955422 Salary: $45.00… more
- Trinity Health (Livonia, MI)
- …**Description:** Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist - REMOTE **Trinity Health at Home is seeking an ... experienced RN Clinical Quality Review Specialist - REMOTE** **Position Summary** The...accurate documentation and plan of care development including visit utilization targets and identification of hospitalization risk to produce… more
- The Arora Group (Bethesda, MD)
- …Certified Occupational Health Nurse (COHN) or Certified Occupational Health Nurse - Specialist (COHN-S). + National Board for Certification in Continuity of ... Registered Nurse Case Manager Nurse Currently recruiting...cost diagnoses. + Independently perform difficult and complex assessment, review , coordination, planning, monitoring, evaluation and analysis of cases.… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- Indian Health Service (Gallup, NM)
- …Indian Medical Center in Gallup, NM. The purpose is to serve as the Nurse ( Utilization Review ) responsible for planning, organizing, implementing, & ... evaluating the functions & requirements of the utilization review . Technical consultation & advice; compiling, analyzing, & interpreting data; monitoring &… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands ... utilization review and coverage guidelines for multiple payers; + Identifies...and reviews findings with all levels of Payment Resolution Specialist for further review . Serve as a… more
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