- 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
- Cleveland Clinic (Weston, FL)
- …or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM ... Utilization Management Specialist Join Cleveland Clinic...Management (UM) Specialists perform UM activities, such as admission review , concurrent review , retrospective chart review… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... health care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in… more
- Community Health Systems (Franklin, TN)
- …nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...documented in the case management system by the UR Review Specialist . + In the event a… more
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... years of start date. + Current licensure as Registered Nurse in the State of Michigan. + Minimum of...+ Minimum of three years clinical experience required. Previous utilization review and/or case management in a… 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
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...Education: Holds a current Texas license as a Registered Nurse . Training and Experience: Three years clinical nursing experience… more
- 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 ... **Job Description** ** Utilization Review Admission Specialist ...and operating room procedures. Seeks the assistance of the Nurse Manager in identifying cases, which require pre admission… more
- Alameda Health System (Oakland, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... System Utilization Management Specialist + Oakland, CA...staff. 8. Per the direction and delegation of the Utilization Management social worker and/or nurse , facilitates,… more
- Penn State Health (Hershey, PA)
- …and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - DAY SHIFT - Utilization ... at ###@pennstatehealth.psu.edu (MAILTO://###@pennstatehealth.psu.edu) **SUMMARY OF POSITION:** Responsible for the review of clinical documentation in the Electronic Medical Record… 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
- Sutter Health (Sacramento, CA)
- …& LICENSURE:** + RN-Registered Nurse of California OR CNS-Clinical Nurse Specialist + BLS-Basic Life Support Healthcare Provider OR ACLS-Advanced ... Support OR PALS-Pediatric Advanced Life Support OR CNOR-Certified Perioperative Nurse OR NRP-Neonatal Resuscitation Provider **EXPERIENE AS TYPICALLY ACQUIRED IN:**… more
- Ascension Health (Baltimore, MD)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- BayCare Health System (Clearwater, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior 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
- MyFlorida (Gainesville, FL)
- REGISTERED NURSE SPECIALIST -F/C OPS - 60957257 Date: Dec 30, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 843860 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C OPS - 60957257 Pay Plan: Temp Position Number:… more
- Sanford Health (Sioux Falls, SD)
- …and execute authorizations. Essential functions must occur simultaneously; therefore, the specialist must be able to appropriately handle and prioritize various ... and members in regards to authorization and/or denial of services. Ability to review , analyze and summarize reports and have effective oral and written communication… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry **Date Posted:** 09/24/2024 **Requisition Number:** CHAP-2270 **Cambridge Health Alliance (CHA)**… more
- McLaren Health Care (Bay City, MI)
- …Bi-Weekly: 0** **Position Summary:** U nder the direction of the Manager, provides utilization review and evaluation of Emergency admissions and direct admits to ... Degree in Nursing. + Two years experience in hospital utilization review . + Minimum of one-year experience...review . + Minimum of one-year experience as charge nurse or leadership role. + Demonstrated competency in patient… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. Remote… more
- Community Health Systems (Birmingham, AL)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... Utilization management is the analysis of the necessity,… more
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