- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... and promotes the efficient and effective use of patient services. The Utilization Review Team's role in data collection, analysis and summarization supports the… more
- Lourdes Health (Pasco, WA)
- …Acute care or community social agency case management experience preferred. Utilization Review experience, preferred. Must possess good assessment, intervention, ... case management strategies pursuant to the Case Management Plan Utilization Review : review charts for...who will unlikely meet anticipated discharge Enters into Abstracting UR/ Nurse Doc UR screen Prioritizes case reviews daily based… more
- UNC Health (Chapel Hill, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...guidelines and policies.Responsibilities:1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …submitted by IEHP delegates.2. Provide leadership and supervision of day-to-day utilization review functions to ensure high-quality, cost-effective services to ... to include training to draft denial language prior to submitting for medical director review . Review Utilization Management data related to timely processing… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …the coordination, implementation, and oversight of the IEHP's overall Utilization Management Out-Patient Operations departmental clinical and operational compliance ... with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities (eg, Prior Authorization, UM Call Center… more
- Wilson Medical Center (Wilson, NC)
- …7. The Case Manager independently performs clinical reviews based on the Utilization Review Plan with follow-up actions identified for medical necessity ... delivery of healthcare services. The Case Manager integrates the roles of Utilization Management, Case Management, and Discharge Planning. The Case Manager is… more
- Central City Concern (Portland, OR)
- …QUALIFICATIONS:License to practice medicine as a medical doctor, osteopathic physician, nurse practitioner, or physician associate in Oregon.Minimum four (4) years ... all providers receive appropriate staff development, in-service training and performance review .Leads the development and teaching of standard work related to… 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
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization ... requests for services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... excelling in this position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- Milford Regional Medical Center (Milford, MA)
- …services to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization ... 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Glens Falls Hospital (Glens Falls, NY)
- …be foundhere. **Job:** **Nursing - Case Management* **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing… more
- Justice, Bureau of Prisons/Federal Prison System (Fort Worth, TX)
- …Medical Care Level 3 facility, or Federal Correctional Complex (FCC). Serves as the Utilization Review Nurse and assists in quality improvement activities ... to the appropriateness of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and… more
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Utilization Review Nurse , you will provide clinical information to insurance ... two times per month. The ideal future caregiver is someone who: + Is a Registered Nurse (RN). + Has two to three years of nursing experience in a med/surg, ICU, or… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and...acute care experience is required as a Licensed Practical Nurse . + Minimum of two (2) years Utilization… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …The Role BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in ... will be required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties… more
- Beth Israel Lahey Health (Burlington, MA)
- …Medical Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three ... Description:** **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… 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
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