- Integra Partners (Troy, MI)
- The Utilization Management ( UM ) Coordinator Supervisor oversees the day-to-day operations and performance of the UM Coordinator team. This position ... teamwork across the department. Salary: $65,000/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES UM Coordinator Supervisor responsibilities include but are… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the...appeals. JOB RESPONSIBILITIES + Monitor incoming faxes + Enter UM authorizations review requests in UM ... HCPC codes + Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred + Knowledge of ICD-10, HCPCS… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt… more
- Tenet Healthcare (Detroit, MI)
- …of care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily, ... RN Utilization Review - Case Management -...an authorization process Closes open cases on the incomplete UM Census Completes the Medicare Certification Checklist on applicable… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review for medical… more
- Trinity Health (Columbus, OH)
- …appropriate. Assist in the development of the Plan's UM Program and the review of the Plan's Utilization Management Plan. **What you will do** + Participates ... in designated committees and task forces according to the UM Program and at the direction of the Director,...Director, Utilization Management. + Coordinates with the utilization review , case management, discharge planning staff… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Management. Your Responsibilities * Receive, research, prioritize and respond to Utilization Management, Case Management, Disease Management ( UM /CM/DM) requests ... apply specific guidelines, policies, and procedures as authorized by the clinical review areas and in coordination with UM /CM/DM activities. * Research… more
- Dignity Health (Oxnard, CA)
- …AHA BLS card **Skills** + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... bonus not to exceed 10% of salary for this position. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Bakersfield, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Glendale, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …pertaining to their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** **Education and Experience** ... **Job Summary and Responsibilities** **JOB SUMMARY / PURPOSE** The Care Coordinator RN is responsible for overseeing the progression of care and discharge planning… 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 ... innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …to enhance the patient experience. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** **Required Education and ... **Job Summary and Responsibilities** Job Summary / Purpose The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for… more
- Actalent (Santa Barbara, CA)
- …modalities, community standards, and professional nursing standards. Essential Skills + Utilization management and review experience. + Strong multi-tasking, ... Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services operational… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- Centene Corporation (Salem, OR)
- …years of clinical nursing or case management experience. Managed care or utilization review experience preferred. **License/Certification:** LPN, LVN, or RN ... services in healthcare or home health settings. Managed care or utilization review experience preferred. **Licenses/Certifications:** Current state license in… more
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