- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review...within the last four (4) years as a registered nurse in utilization management. + One (1)… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... utilization reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance with industry… more
- University Health (Hondo, TX)
- …Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... any qualifications that applicants are expected to have. The nurse case manager coordinates, in collaboration with the patient...licensure as a Registered Nurse with the Texas State Board of … more
- University Health (Pleasanton, TX)
- …Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... pertaining to this job in the description below. The nurse case manager coordinates, in collaboration with the patient...licensure as a Registered Nurse with the Texas State Board of … more
- Katmai (Fort Carson, CO)
- …as needed to provide direction in care management. + Plan and prioritize utilization review (UR) activities to ensure identified patient needs are addressed ... record data. + Facilitate the development and integration of utilization management (UM) review policies and procedures...last two (2) years as a practical or vocational nurse . + Current, full, active, and unrestricted license as… more
- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
- Battelle Memorial Institute (Colorado Springs, CO)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...programs for equal treatment of all staff and full utilization of all qualified employees at all levels within… more
- Yale New Haven Health (West Haven, CT)
- …individuals and professionals, every day. Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered Nurse (Rn) Assesses, Plans, ... Functions As A Preceptor To New Staff. Functions As A Charge Nurse . Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization ,… more
- Yale New Haven Health (Danbury, CT)
- …individuals and professionals, every day. Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered Nurse (Rn) Assesses, Plans, ... Functions As A Preceptor To New Staff. Functions As A Charge Nurse . Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization ,… more
- Katmai (Usaf Academy, CO)
- …same duties as those required of any military or government civil service nurse of similar experience and in similar duty assignments. **ESSENTIAL DUTIES & ... all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. Adhere… more
- ERP International (Camp Pendleton, CA)
- **Overview** ERP International, LLC is seeking a **Licensed Vocational / Practical Nurse ** for a full-time position supporting the **Branch Health Clinics** at ... manuals, reports and actively engages patients in their health care. + Review details and expectations regarding referrals with patients. + Provide support to… more
- Luke Staffing (Glendale, CO)
- **REGISTERED NURSE ** **SITE OF SERVICE:** Department of Veterans Affairs, Eastern Colorado Healthcare System (ECHCS), 4100 E. Mississippi Ave, Glendale, CO 80246 ... consider Part Time and Full Time Applicants** **POSITION OVERVIEW:** The Registered Nurse (RN) will provide on-site professional nursing services to beneficiaries of… more
- Christus Health (San Antonio, TX)
- …Medicare GMLOS by managing per Milliman/Interqual Care Guidelines. Resource/ Utilization Management/appropriateness: Assess assigned patient population for medical ... Proactively refers cases to physician adviser for P2P, medical necessity review , and denail avoidance. Demonstrates and maintains current knowledge of regulatory… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Health Educator** supporting **Naval Medical Center San Diego, CA ... of other individuals performing similar services. ? Participate in peer review and performance improvement activities. ? Practice aseptic techniques as necessary.… more
- Fresenius Medical Care (Atlanta, GA)
- …auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials ... including efficient utilization of supplies or equipment and regular profits and loss review . Responsible for all required network reporting and on-site state or… more
- Fresenius Medical Care (Fayetteville, NC)
- …all FMS manuals. Accountable for completion of the Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper or voice mail, ... required supporting billing and collection activities. Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... other interdisciplinary team members; arranges followup care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …bundling edits, and recommend action steps regarding code configuration issues, annual utilization and review analysis. + Maintain current knowledge of coding ... procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy development… more
