- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily...documents, and codes and reports the data to the Utilization Management Inpatient Coordinator and Inpatient Nurses.13.… more
- Centene Corporation (Sacramento, CA)
- …levels of care and facilities + Partners with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners ... findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and… more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- McLaren Health Care (Detroit, MI)
- …**Essential Functions and Responsibilities as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...support the level of care being billed . Conducts concurrent reviews to ensure criteria for patient status and… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization ... commercial and government payers. This individual is responsible for concurrent and continued stay Utilization Management...+ Required: + Currently licensed as a Registered Professional Nurse in New York State. + Associates Degree +… more
- Martin's Point Health Care (Portland, ME)
- … required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment required ... has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Nurse BH WFH you want with your current employer? We have an ... of colleagues. Do you want to work as a(an) Utilization Review Nurse BH WFH where your...behavioral health experience required** + **1-3 years relevant case management / utilization review experience preferred** +… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** Utilization Management Nurse - Weekend Front End Review utilizes clinical nursing ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- McLaren Health Care (Bay City, MI)
- …resolution. **Essential Functions and Responsibilities:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... denied cases. 5. Assists with monitoring the effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- Independent Health (Buffalo, NY)
- …and Accountable. **Essential Accountabilities** + Provide high quality, professional utilization management services: (medical necessity review for Prior ... benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to...review.) + Prompt, courteous, and error free in performing utilization management functions. + Available to answer… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** Full Time, 40 hours weekly, Monday - Friday 7:30am - 4pm + **Hospital:** Ascension Via ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- UNC Health Care (Rocky Mount, NC)
- …hospital, continued stay, and use of other hospital services in accordance with Utilization Management Plan, Conditions of participation (CoP) and other federal ... (physicians, other health care professionals, payers, etc.) to identify appropriate utilization of hospital resources and to ensure timely reimbursement for services… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited...Degree in a health related field. + 3 Years Utilization Management or case management … more
- Centene Corporation (Atlanta, GA)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral ... level of care setting for continued treatment. Employs the utilization management process to assist in setting...regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at… more
- Hackensack Meridian Health (Hackensack, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more