- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II...on the basis of age for any individual age 40 or older. c. Experience is evaluated on the basis ... Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,161.60 -...of a verifiable 40 - hour week, unless specified otherwise. Prorated part-time experience… more
- Ascension Health (Wamego, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Aspen Medical (Aurora, CO)
- …and Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP), Certified Informatics Nursing, Ambulatory Care ... JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical...in a direct patient care clinical setting. Must have utilization management, utilization review or… more
- Texas Health Resources (Arlington, TX)
- **RN/Registered Nurse - Utilization Management, Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort Worth ... criteria preferred **Licenses and Certifications** + RN - Registered Nurse Current license to practice professional nursing in the...care team. + Determine working DRG with each initial review via CareConnect1 or other Utilization Management… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing… more
- Sutter Health (Sacramento, CA)
- …Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California OR CNS-Clinical Nurse Specialist + BLS-Basic Life ... Support OR PALS-Pediatric Advanced Life Support OR CNOR-Certified Perioperative Nurse OR NRP-Neonatal Resuscitation Provider **EXPERIENE AS TYPICALLY ACQUIRED IN:**… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... implement quality review programs and key performance indicators for all utilization review activities. + Interact with medical, nursing, and executive… more
- Community Health Systems (Franklin, TN)
- …nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse ... healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed...of medical services and procedures in the hospital setting. Utilization review is the assessment for medical… more
- Covenant Health (Bangor, ME)
- …of the VP of Accountable Care Operations & Population Health Strategy the Utilization Review Case Manager will work collaboratively with other members of ... the healthcare team. The nurse case manager also acts as an advocate for...Manager conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed… more
- Providence (Missoula, MT)
- …Schedule:** Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 3500 UTILIZATION REVIEW **Address:** MT Missoula 500 W Broadway **Work ... **Description** The Nurse Case Manager (NCM) is responsible to manage...not-for-profit network of services also include physicians, more than 40 clinics, care centers, hospice and home health programs,… more
- ERP International (Nellis AFB, NV)
- …the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the appropriate ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
- UNC Health Care (Raleigh, NC)
- **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review for Surgical admissions** Become part of an inclusive ... organization with over 40 ,000 diverse employees, whose mission is to improve the...through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Hackensack Meridian Health (Neptune, NJ)
- …**Hackensack Meridian** **_Health_** includes: + Follows departmental workflows for utilization review activities including admission reviews, admission denials, ... as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team...as required by payer agencies and initiates physician advisor's review as necessary for unwarranted admissions. + Performs chart… more
- Hackensack Meridian Health (Holmdel, NJ)
- …at Hackensack Meridian _Health_ includes: + Follows departmental workflows for utilization review activities including admission reviews, admission denials, ... as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team...as required by payer agencies and initiates physician advisor's review as necessary for unwarranted admissions. + Performs chart… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Head Nurse ( 40 Hour) Office/On-site Recruitment # 250115-4356FL-001 Location Hartford, CT Date Opened 1/22/2025 12:00:00 AM Salary $91,192 - $120,638/year ... DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) is currently recruiting for a Head Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=4356FL&R1=&R3=) with exceptional attention to detail and a… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** Remote -… more
- Humana (Columbus, OH)
- …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge… more
- University of Rochester (Strong, AR)
- …for all UM customers. Other duties as assigned. **QUALIFICATIONS** + RN with Utilization Review experience preferred; 3-5 years of recent acute hospital ... 14642 **Opening:** Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: UR - Day (United… more
- G-TECH Services, Inc. (Detroit, MI)
- …which may include acute patient care, discharge planning, case management, and utilization review , etc. Demonstrated clinical knowledge and experience relative ... requirements: Associate Degree or nursing diploma required, Triage, case management or utilization review experience, Expertise in the use of medical… more
- G-TECH Services, Inc. (Detroit, MI)
- …which may include acute patient care, discharge planning, case management, and utilization review with another insurance provider, etc. Demonstrates clinical ... specialized field such as NICU/OB/BH/Substance Abuse * * InterQual/MCG or other utilization review experience preferred Required Skills/Experience - The rest of… more