- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview The Utilization Management Review Supervisor manages a remote team of clinical reviewers who process prior authorization requests for Community ... Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers Clinical and technical support: Offer guidance on clinical and… more
- Kaiser Permanente (Pleasanton, CA)
- …by: researching corrective action plan for areas of improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... stakeholders to develop resolutions. Develops stakeholder development and quality performance review processes by: developing and improving the utilization and… more
- Sharp HealthCare (San Diego, CA)
- …Regular Shift Day FTE 1 Shift Start Time Shift End Time California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree Hours : Shift Start ... in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to...implemented for compliance, as needed. + As a unit supervisor at the LA General Medical Center: + Has… 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 ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... in a payer or managed care environment. + Strong understanding of utilization review , authorizations, and appeals processes. + Excellent verbal/written… more
- BJC HealthCare (St. Louis, MO)
- …of RN experience performing care for hospitalized patients + 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity + ... quality of medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and over- utilization … 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
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical 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… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... services + Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials....Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- State of Colorado (Denver, CO)
- Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health Hospital Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5132944) Apply Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... providers to collect all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion to retain requests for… more
- HCA Healthcare (Manchester, NH)
- …we encourage you to apply for our PRN House Supervisor RN Registered Nurse opening. We review all applications. Qualified candidates will be contacted for ... have the PRN career opportunities as a(an) PRN House Supervisor RN Registered Nurse you want with...meetings with hospital staff to identify and communicate bed utilization issues . With inpatient coordinators and clinical staff… more
- University of Utah Health (Salt Lake City, UT)
- …reassign staff based on census and workload, adhering to the Nurse Utilization Policy. + Assist Hospital Supervisor and Nursing Leadership in identifying ... + Coordinate and communicate real-time staffing changes in conjunction with the Hospital Supervisor . + Review open shift requests and secure coverage as needed.… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt… more
- Bassett Healthcare (Cooperstown, NY)
- …specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Operating Room / Perioperative Services unit ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a new nurse… more
- Northwell Health (Bay Shore, NY)
- …of patients admitted to the Hospital. Job Responsibility + * Performs concurrent review on all patients and share all problematic cases with the Supervisor ... care patterns or cases and make referrals to the Supervisor and the department involved. + * Performs retrospective...as required. + * Participates in the maintenance of Utilization Management, Discharge Planning and Case Management statistics as… more
- Bassett Healthcare (Herkimer, NY)
- …enjoy the best quality of life possible. What you'll do The Registered Professional Nurse I, Acute Care is accountable for the delivery of safe patient care ... and job description is only appropriate for a new nurse in the first year of practice, as support...than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. +… more
- Bassett Healthcare (Cooperstown, NY)
- …and enjoy the best quality of life possible. What you'll do The Discharge Nurse is accountable for the delivery of safe patient care utilizing the nursing process. ... The Discharge Nurse assesses, plans, delivers, coordinates, integrates, and evaluates nursing...than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback +… more
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