- 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 ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Katmai (Fort Carson, CO)
- …or American Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management. + One (1) year of experience in ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… 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
- Nuvance Health (Poughkeepsie, NY)
- …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... skills License, Registration, or Certification Requirements: Current New York State a Registered Nurse license. PREFER: QAPI certificate. Company: HQ Home… more
- Christus Health (Euless, TX)
- …in CHRISTUS RN Care Manager I position. Case management and Utilization Review experience preferred. Licenses, Registrations, or Certifications RN ... all of the information that follows below. Summary: The RN Care Manager (CM) II works with physicians and...patient need, manage length of stay and promote efficient utilization of resources to include the facilitation of patient… more
- Luke Staffing (Glendale, CO)
- …holidays) **Will consider Part Time and Full Time Applicants** **POSITION OVERVIEW:** The Registered Nurse ( RN ) will provide on-site professional nursing ... ** REGISTERED NURSE ** **SITE OF SERVICE:** Department...of Veterans Affairs' Eastern Colorado Healthcare System (ECHCS). The RN will serve in the Office of Community Care… more
- ERP International (Luke AFB, AZ)
- **Overview** ERP International is seeking a full time ** Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health… more
- Katmai (Usaf Academy, CO)
- …RESPONSIBILITIES** None. **Job Requirements:** **MINIMUM QUALIFICATIONS** + Associates Degree of Nursing. Registered nurse shall be a graduate from a college or ... those required of any military or government civil service nurse of similar experience and in similar duty assignments....+ Shall possess a current, active, full and unrestricted Registered Nurses ( RN ) licensed in Colorado or… 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
- Community Health Systems (Franklin, TN)
- …accuracy. Knowledge of HIPAA regulations and patient confidentiality standards. Licenses and Certifications RN - Registered Nurse - State Licensure and/or ... Job Summary The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… 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. ... reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance...Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California.… more
- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview The Utilization Management Review Supervisor manages a remote team of clinical reviewers who process prior authorization requests for Community ... oversight, support, and direction to a remote team of Utilization Management Reviewers Clinical and technical support: Offer guidance...Nurse Licensure Compact (NLC) required Ability to obtain RN in District of Columbia within 6 months from… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... | Stanford Health Care (SHC)? Are you a seasoned RN Case Manager? Here is your opportunity to work...include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review … more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager ... Job Description RN /Case Manager MSH Case Management FT Days The...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- … RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and network facilities to ... 8:00 AM - 5:00 PM CST (Flexible) **Responsibilities** A. Performs necessary review to ensure compliance with HHSC and other regulatory entities + Collaborate:… more
- Elara Caring (Fort Worth, TX)
- …Identifies and reports potential payment/coverage problems. Supervises and coordinates utilization review activities. Participates in strategic development of ... Key Accounts, including participation in weekly, monthly, and quarterly review meetings, as needed. Ensures accuracy of all public...as required by state or federal guidance Licensed physician, registered nurse or holds an undergraduate degree… more
- Ascension Health (Pensacola, FL)
- …in the case management department. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the Florida Board of Nursing ... of proven leadership or management experience, preferably overseeing Case Management or Utilization Review teams in an Acute Care setting. Certification: Current… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Kaiser Permanente (Olympia, WA)
- …collaborating with care team members. Preferred Qualifications Minimum two (2) years of RN experience in utilization review , ambulatory case management, care ... coordination or disease management. Education Bachelors degree License, Certification, Registration Registered Nurse License (Washington) required at hire OR… more
- Stanford Health Care (Palo Alto, CA)
- …Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the ... and adherence to policy through practice analysis and case review of APPs with physicians. . Investigate and respond...under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse… more
