- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review...within the last four (4) years as a registered nurse in utilization management. + One (1)… more
- Alameda Health System (San Leandro, CA)
- …Follows AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization...EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in… more
- Katmai (Fort Carson, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Valero (San Antonio, TX)
- …industry experience and proficiency with Disability Management (STD/LTD), Workers' Compensation, Utilization Review , and/or nurse case management preferred. ... throughout the claim process. * Coordinates with third-party medical review vendors for complex or extended claims. * Evaluates...or Legal. * Provides guidance and explanations of medical review protocols and claim decisions to employees and HR… more
- Battelle Memorial Institute (Homestead AFB, FL)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...programs for equal treatment of all staff and full utilization of all qualified employees at all levels within… more
- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
- Katmai (Usaf Academy, CO)
- …same duties as those required of any military or government civil service nurse of similar experience and in similar duty assignments. **ESSENTIAL DUTIES & ... all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. Adhere… more
- ERP International (Camp Pendleton, CA)
- **Overview** ERP International, LLC is seeking a **Licensed Vocational / Practical Nurse ** for a full-time position supporting the **Branch Health Clinics** at ... manuals, reports and actively engages patients in their health care. + Review details and expectations regarding referrals with patients. + Provide support to… more
- Luke Staffing (Glendale, CO)
- **REGISTERED NURSE ** **SITE OF SERVICE:** Department of Veterans Affairs, Eastern Colorado Healthcare System (ECHCS), 4100 E. Mississippi Ave, Glendale, CO 80246 ... consider Part Time and Full Time Applicants** **POSITION OVERVIEW:** The Registered Nurse (RN) will provide on-site professional nursing services to beneficiaries of… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a temporary **Registered Nurse (RN) Health Educators** 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
- ERP International (San Diego, CA)
- …of the room team members to ensure optimal patient care and effective utilization of resources (personnel, supplies, and equipment). + Verifies surgical site(s) and ... of other individuals performing similar services. + Participate in peer review and performance improvement activities. + Practice aseptic techniques as necessary.… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... team members; arranges follow up care as appropriate. + Utilization Review - Review prospectively,...patient health care **Licenses and Certifications** + CA-RN (Registered Nurse ) required **These principles apply to ALL employees:** **SHC… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …bundling edits, and recommend action steps regarding code configuration issues, annual utilization and review analysis. + Maintain current knowledge of coding ... procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy development… more
- Stanford Health Care (Palo Alto, CA)
- …development of their APPs. The Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse ... and adherence to policy through practice analysis and case review of APPs with physicians. . Investigate and respond...development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS),… more
- Stanford Health Care (Palo Alto, CA)
- …growth and development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered ... clinical competency and adherence to policy through practice analysis and case review of APPs with physicians. + Investigate and respond to patient/family complaints… more
- Stanford Health Care (Palo Alto, CA)
- …clinical competency and adherence to policy through practice analysis and case review of APPs with physicians. + Investigates and responds to patient/family ... practice based on evidence by using research based knowledge or research utilization methods to identify and implement innovations in patient care and/or… more
- Stanford Health Care (Palo Alto, CA)
- …Brief Overview** The Oncology Research Nursing Professional (ORNP) -is a Registered Nurse (RN) who works collaboratively with Clinical Research Staff including, but ... triage of phone calls and proactive patient communication. The Oncology Research Nurse Professional -serves to educate patients and families on the clinical trial… 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...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Oklahoma City County Health Department (Oklahoma City, OK)
- …work assignments. 4. Supervising employee activities by direct observation and review of job products. 5. Monitoring and evaluating employee performance, attendance, ... and leave utilization . 6. Completes performance evaluations on clinic staff including any discipline. 7. Maintains supervisory documentation and files on all… more
- Battelle Memorial Institute (Tampa, FL)
- …+ Under the supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health ... program policy + Coordinate attendance and agenda at Case Review Committee with military and civilian agencies + Coordinate...programs for equal treatment of all staff and full utilization of all qualified employees at all levels within… more
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