- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively ... this position is able to cover a multitude of utilization review functions through point of entry,...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… 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...A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed… more
- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- CareFirst (Baltimore, MD)
- …Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze...in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse -… more
- WestCare Foundation (Henderson, NV)
- … RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric or ... substance use disorder Experience and Competencies: + Proven experience in conceptualizing a case and creating a clinical impression to present to all involved and approved parties, including managed care representatives + Knowledge of CPT, ICD 9 & ICD 10… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/ RN responsibilities ... + **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred...Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St… more
- Deloitte (Los Angeles, CA)
- …degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical Documentation Specialist - CCDS (inpatient) ... registered nurse , physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN , Quality,… more
- Tufts Medicine (Melrose, MA)
- …role is essential in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with ... managers, TMIN Practice Optimization Coaches (POMs) and primary care providers to review patient records, analyze data, and identify practice and patient outlier … more
- Cedars-Sinai (Los Angeles, CA)
- …Los Angeles Fair Chance Initiative for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days ... care field preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician… more
- McLaren Health Care (Bay City, MI)
- . **Position Summary:** U nder the direction of the Manager, provides utilization review and evaluation of Emergency admissions and direct admits to assist in ... * Licensed by the State of Michigan as a Registered Nurse . * Three years experience as...Degree in Nursing. * Two years experience in hospital utilization review . * Minimum of one-year experience… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review … more
- MyFlorida (Land O' Lakes, FL)
- …that all verbal orders, including telephone orders from attending physicians are received by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50000070 Date:...current status and providing supervision and guidance to the RN , LPN, CNA and other Allied Health Care Professionals.… more
- MyFlorida (Port Charlotte, FL)
- …all verbal orders, including telephone orders from attending physicians, are received by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50009026 Date:...resident's status and providing supervision and guidance to the RN , LPN, CNA, and other Allied Health Care Professionals.… more
- MyFlorida (Chattahoochee, FL)
- …ALL SHIFTS. This is a highly responsible and professional position serving as a Registered Nurse Specialist within Nursing Services. The ideal candidate will ... REGISTERED NURSE SUPERVISOR - 60005446 Date:...physician orders. + Providing medical emergency and emergency pregnancy review /drills on shift assigned. + Providing immediate intervention to… more
- HCA Healthcare (Greenwood Village, CO)
- …DeterminationsSupervisory experience preferredCertifications, Licenses, and other Special RequirementsCurrent/Active Registered Nurse ( RN ) License within ... regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records...we encourage you to apply for our Clinical Manager Registered Nurse opening. We promptly review… more
- Cedars-Sinai (Beverly Hills, CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and...for Hiring. **Req ID** : 12949 **Working Title** : Registered Nurse - ISP Care Coordinator -… more
- City of New York (New York, NY)
- …required; make professional recommendations accordingly. - Keep abreast of medical and utilization review techniques and developments relative to the nursing ... Nurse in the Bureau of Medical and Professional Review (BMPR) of Home Care Services Program. As the...- 50935 Qualifications 1. A valid New York State Registered Nurse License and completion of one… more
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