- Community Health Systems (Franklin, TN)
- …a key contact for facility staff and insurance representatives regarding utilization review concerns. Supports training initiatives within the department and ... Job Summary The Clinical Utilization Review Specialist is responsible for...patient confidentiality standards. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required… 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
- 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 ... In this role, you will provide clinical, technical, and operational guidance to staff , oversee workflow and inventory, and ensure the team meets its goals through… more
- University Health (Pleasanton, TX)
- …Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration with the...is preferred. LICENSURE/ CERTIFICATIONS Current licensure as a Registered Nurse with the Texas State Board of Nurse… more
- University Health (Pleasanton, TX)
- …Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization ... pertaining to this job in the description below. The nurse case manager coordinates, in collaboration with the patient...is preferred. LICENSURE/ CERTIFICATIONS Current licensure as a Registered Nurse with the Texas State Board of Nurse… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Sharp HealthCare (San Diego, CA)
- …Regular Shift Day FTE 1 Shift Start Time Shift End Time California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree Hours : Shift Start ... in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning… 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 ... are not limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Community Health Systems (Naples, FL)
- …for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and transitions of care. The role ... delivered efficiently, effectively, and in compliance with organizational standards. Oversees utilization review and discharge planning processes to ensure… more
- Kaiser Permanente (San Francisco, CA)
- …environment. Preferred Qualifications: Minimum two (2) years of experience in utilization review , case management, and discharge planning preferred. Bachelors ... Job Summary Coordinates with physicians, staff and non-Kaiser providers and facilities regarding patients transitions and discharge planning. In conjunction with… more
- University Health (Boerne, TX)
- …recent, full time hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- Novo Nordisk Inc. (Los Angeles, CA)
- …relationships include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, diabetes educators, pharmacists, blood bank staff , ... providers and IHNs; c) develops appropriate use of NNI products and greater utilization of its services d) supports and assists representatives and managers in… more
- Houston Methodist (Baytown, TX)
- …care. The Director Nursing position works in cooperation with the Medical Staff to ensure regulations and accreditation standards are maintained. The Director ... position responsibilities include overseeing the activities of the department staff , ensuring quality, productivity, functional excellence and efficiency to… more
- University Health (Pleasanton, TX)
- …recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. ... and communication skills for serving in the liaison roles with medical staff , nursing, and patients and families. EDUCATION/EXPERIENCE Graduation from an accredited… more
- Insight Global (Elkton, MD)
- …Cable Plant and wireless IP phones. Support and provide technical guidance to the Field Staff . Support of the Nurse Call backend systems. This is an ONSITE ... which includes a monthly report on traffic and effective utilization . 9. Oversees the weekly work efforts of the...the weekly work efforts of the contracted vendor technical staff . 10. Maintain the Nurse Call servers… more
- Houston Methodist (Houston, TX)
- …of Root Cause Analysis (RCA), Failure Modes Effects Analysis (FMEA), or event review as needed. Supports leadership and staff with the development and ... safety and evidence-based practice awareness and practice among clinicians and staff through mentoring and education. Manages project and process improvement… more
- Elara Caring (Fort Worth, TX)
- …Identifies and reports potential payment/coverage problems. Supervises and coordinates utilization review activities. Participates in strategic development of ... to make a difference Competitive compensation package Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost… more
- Fresenius Medical Care North America (Riverside, CA)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. Training ... all data collections and auditing activities. Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss … more
- UnitedHealth Group (Omaha, NE)
- …state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or ... of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review Occasionally, may participate in periodic market oversight meetings with the… more
- Dana-Farber Cancer Institute (Foxboro, MA)
- …Provides superior customer service to all patients, family members, physicians and staff at all times in accordance with the DFCI Customer Service Standards. ... practitioner group consisting of physicians, physician's assistants, program nurses and nurse practitioners and other care providers, the individuals in this… more
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