- 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
- 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 CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Bluestone Child & Adolescent Psychiatric Hospital (University Heights, OH)
- …as a psychiatric nurse . 1-2 years-experience in behavioral health utilization review preferred. AGENCY SUMMARY: Bluestone is seeking dynamic healthcare ... Psychiatric Intake Nurse - FT Nights, 5-8 hour shifts- Sunday through...timely response to emails and other communications relating to utilization review . Prepare and submit appeals utilizing… more
- Aveanna Healthcare (Birmingham, AL)
- …the plan of care and patient needs. Participates in quality improvement, utilization review , and infection control activities as requested. Attends appropriate ... Position Overview: The Hospice Registered Nurse is responsible for pain management, symptom control...coordination. Collaborates with the interdisciplinary team in the development, review and revision of the clinical component of patient/family… more
- Katmai (Fort Carson, CO)
- …as needed to provide direction in care management. + Plan and prioritize utilization review (UR) activities to ensure identified patient needs are addressed ... record data. + Facilitate the development and integration of utilization management (UM) review policies and procedures...last two (2) years as a practical or vocational nurse . + Current, full, active, and unrestricted license as… 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
- Battelle Memorial Institute (Colorado Springs, CO)
- …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
- 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 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
- Greenspring Village by Erickson Senior Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... Location: Greenspring Village by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical Manager! The Clinical Manager is an active… 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 ... other interdisciplinary team members; arranges followup care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… 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 ... provide requested clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
- Valley Health System Consolidated Services (Las Vegas, NV)
- …minimum three years experience in varied clinical settings. Two years experience in Utilization Review , Utilization Management or Case Management preferred. ... establishing a safe, individualized discharge and providing proficient timely utilization management services to ensure that maximum reimbursement is...Has a current license to practice as a Registered Nurse in the State of Nevada. Other: Must be… 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
- Valley Health System Consolidated Services (Las Vegas, NV)
- …minimum three years experience in varied clinical settings. Two years experience in Utilization Review , Utilization Management or Case Management preferred. ... establishing a safe, individualized discharge and providing proficient timely utilization management services to ensure that maximum reimbursement is...Has a current license to practice as a Registered Nurse in the State of Nevada. Other: Must be… more
- Houston Methodist Specialty Physician Group (Webster, TX)
- …population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie Hand Hygiene ... visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow prior to… more
- Houston Methodist Specialty Physician Group (Houston, TX)
- …level tasks under the direct supervision of a Physician and/or Registered Nurse for assigned patient populations, for providing high quality support of patient ... visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow prior to… 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
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