- Prime Healthcare (Weslaco, TX)
- …#registerednurse #casemanagement Connect With Us! (https://careers-primehealthcare.icims.com/jobs/188814/registered- nurse -case- manager utilization ... perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... weekend and holiday schedule.** **Purpose:** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization … more
- Lowe's (Charlotte, NC)
- …years of experience in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in ... license in home State + CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse...or local law._ _Qualified applicants with arrest or conviction records will be considered for Employment_ _in accordance with_… 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: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical regulatory ... Manager to facilitate coordination of services related to utilization review. Collaborates with the multidisciplinary team, lending professional...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… 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 ... , and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- VNS Health (Manhattan, NY)
- … or an Occupational Therapist in New York State required + Certified Case Manager preferred + For SelectHealth ETE Only: Nurse Practitioner (NP) certification ... cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the management, ... containment activities, and services on automated UM review. The Program Manager will ensure accurate implementation, system configuration and appropriate benefit… more
- Morris Hospital (Morris, IL)
- …evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure ... reimbursement for services provided to patients. Role includes accessing medical records to perform ongoing performance improvement audits. + QUALIFICATIONS +… more
- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking **Registered Nurse (RN) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military ... admissions, including all eligible beneficiaries, to civilian hospitals and notifies Clinical Nurse Case Manager and Patient Administration Element as required.… more
- Stanford Health Care (Palo Alto, CA)
- …delivering evidence-based and patient-centered care. We are seeking a results-driven manager to further develop the framework for clinical, operational, and ... Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships,… more
- Elevance Health (Tampa, FL)
- …health plans for people enrolled in Medicaid and/or Medicare programs in Florida. ** Manager II GBD Special Program** **Location:** This position will work a hybrid ... days may be required based on operational needs. The ** Manager II GBD Special Program** is responsible for supporting...program schedule, budget, and resources plan. + Manages resource utilization to ensure appropriate delivery of care to members… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189323/case- manager utilization -review/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.… more
- Hackensack Meridian Health (Neptune, NJ)
- …concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and evaluates medical records for inpatient ... healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- Hackensack Meridian Health (Holmdel, NJ)
- …concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and evaluates medical records for inpatient ... healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- Munson Healthcare (Traverse City, MI)
- …proficiency in the use of hospital information systems to access information and record data. Continuing Stay + Actively participate in daily huddles, patient care ... patient's clinical status and progression of care. + Consults with case manager and/or physician advisor as necessary to resolve progression-of-care barriers through… more
- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are unable ... Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse or Licensed Registered NursePreferred License/Registration/Certification: ACM or CCM… more
- Molina Healthcare (Columbus, OH)
- …AM to 5 PM EST **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... For this position we are seeking a (RN) Registered Nurse who lives in OHIO or KENTUCY and must...Adheres to departmental standards, policies, protocols. + Maintains detailed records of auditing results. + Assists HCS training team… more
- BronxCare Health System (Bronx, NY)
- …Customer Service. - Reviews and denials notification letters along with the medical records and all pertinent documentation related to the episode of care being ... and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate with ECFMG… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
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