- Pacer Staffing (Atlanta, GA)
- …Provides Disease Management (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and evaluate the ... the beneficiary to successfully manage their chronic condition. . The DM nurse will partner with the interdisciplinary care team to identify appropriate care… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator...care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; + May review ... Hospital - is accepting applications for one (1) full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
- US Tech Solutions (Chicago, IL)
- …MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION ... with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- US Tech Solutions (May, OK)
- …MANAGED CARE exp and Medicare /Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… 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 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …responsible for completing the Medical Policy activities outlined in BCBSLA's Medicare Advantage Medical Policy Development Policies & Procedures locating, tracking ... heavy workloads accurately. **Licenses and Certifications** + Health Services\RN - Registered Nurse - State Licensure And/or Compact State Licensure to practice in… 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 Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN 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 Clinical Quality Nurse Reviewer RN II, under the purview the… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Humana (Des Moines, IA)
- …interpretation and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- LifePoint Health (Athens, TN)
- …Centeris currently seeking talent to fill the position of Intake Nurse and Utilization Specialist for ourGeroPsychDepartment.This job is permanent,full-time. ... **Nursing* **Organization:** **Starr Regional Medical Center* **Title:** * Intake Nurse and Utilization Specialist * **Location:** *Tennessee-Athens*… 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 ... procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely… more
- New York State Civil Service (New York, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Manhattan Psychiatric Center, P25480 Occupational Category Health… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals. The Utilization Review Specialist (LVN) is ... or Centers for Medicare and Medicaid (CMS) and healthplan requirements. The Utilization Review Specialist (LVN) will serve as liaison and primary point of… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct initial, concurrent,… more
- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Molina Healthcare (Long Beach, CA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- CareFirst (Baltimore, MD)
- …detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services. ... Upon Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
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