- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to...to serve America-s military family by aligning exceptional healthcare workers like you with rewarding career opportunities. Come home… more
- Lowe's (Charlotte, NC)
- …clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker 's compensation + Experience in a clinical position + ... including psychosocial factors, for catastrophic and complex cases on workers ' compensation injuries. Responsible for ensuring that employees receive appropriate… more
- Apex Health Solutions (Houston, TX)
- …Certification requirements, as well as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing ... Licensed Vocational Nurse required and current unrestricted Certification in Utilization Review / Utilization Management preferred Qualifications: One (1)… more
- Ochsner Health (New Orleans, LA)
- …hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in ... + Maintains knowledge of the conditions of participation as it relates to utilization review and discharge planning. + Maintains open communication with all… more
- Veterans Affairs, Veterans Health Administration (San Juan, PR)
- Summary The Utilization Management Nurse (UMN) serves as a subject matter expert in the clinical criteria at the facility level and conducts clinical reviews of ... and creative approaches to management of patient care. Responsibilities The Utilization Management Nurse (UMN) demonstrates expertise in the professional… more
- Veterans Affairs, Veterans Health Administration (Tucson, AZ)
- Summary The Utilization Management Registered Nurse makes decisions that reflect distinct and contributory supporting roles of nursing; is responsible for ... quality of patient care as well as the appropriateness of services provided. The UM Nurse Reviewer is a generalist and reports directly to the Nurse Manger. The… more
- Ochsner Health (New Orleans, LA)
- …interpersonal and conflict resolution skills. **Job Duties** + Lead and directs Utilization Review (UR) staff and functions, including staffing, staff ... reviews to identify escalation issues regarding Providers, other facility issues, individual utilization review staff skills, payor-based concerns and to provide… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …facilitates interdisciplinary team collaboration, from admission through discharge. He/she will review medical records and accurately document UM reviews in NUMI ... following the VACO UM process and the InterQual review process. He/she will facilitate and coordinate admissions to the most appropriate level of care. He/she will… more
- AdventHealth (Shawnee, KS)
- **Inpatient Social Worker OR RN-Case Manager Weekend Worker Program Days** **All the benefits and perks you need for you and your family:** + Vision, Medical & ... time and a half as part of the Weekend Worker Program + 6 weekend shifts off per year...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Centene Corporation (Tucson, AZ)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... licensure who reside in Arizona with experience in mental health settings and utilization management / review . **Position Purpose:** Performs a clinical … more
- Centene Corporation (Tucson, AZ)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... who reside in Arizona with experience in mental health settings and utilization management / review . **Position Purpose:** Performs reviews of member's… more
- Community Health Systems (Franklin, TN)
- …nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse ... appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for… more
- State of Massachusetts (Boston, MA)
- …and partner agency. * Facilitate/coordinate return to work - full/modified duty. * Review reporting of opioid utilization via pharmacy benefit management program ... role. **Job:** **Administrative Services* **Organization:** **Human Resources Division* **Title:** * Workers ' Compensation Telephonic Nurse Case Manager* **Location:**… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Review Admission Specialist (OR Scheduler), Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The ... Utilization Review Specialist coordinates scheduling of all...and operating room procedures. Seeks the assistance of the Nurse Manager in identifying cases, which require pre admission… 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...resources. The NCM coordinates with physicians, Case Management Social Worker , and other health team members to expedite medically… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/189319/case-manager%2c-rn utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: * Uses approved criteria and conducts ... the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review … more
- Ochsner Health (Lafayette, LA)
- …or other related MCO departments/functions. **Certifications** Required - Current registered nurse (RN) license in state of practice. *MSW accepted in lieu ... of registered nurse (RN) licensure. Preferred - Certification in Case Management...Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains… more
- Centene Corporation (Tallahassee, FL)
- …in the State of Florida **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more