- Veterans Affairs, Veterans Health Administration (Lebanon, PA)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of ... and analytical review of clinical information. Responsibilities The Revenue Utilization Review (RUR) Registered Nurse is under the supervision of a … more
- Trinity Health (Springfield, MA)
- …**Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** performs utilization ... using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization ...and their families. **What you will do** + Perform utilization review and payer notification + Establish… more
- MetroHealth (Cleveland, OH)
- …patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is ... and time management skills. Preferred: Two years of experience with case management, utilization review . Physical Demands: May need to move around intermittently… more
- Ascension Health (Baltimore, MD)
- …with your Talent Advisor for additional specifics._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... implement quality review programs and key performance indicators for all utilization review activities. + Interact with medical, nursing, and executive… more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization ... Bachelor's Degree Nursing Or + Associate's Degree Nursing + 3 years of Utilization Review , Care Management, Quality Management, and/or Discharge planning **Why… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …a Certified Professional Coder required. + Three to five years of case management utilization review , or compliance related work experience in a hospital setting ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete… more
- Sharp HealthCare (San Diego, CA)
- …and internal transfer requests and direct admission requests. This position supports utilization review functions to ensure appropriate patient status and ... while ensuring compliance with all local, state and federal regulations governing utilization review activities and/or care management. Expected outcomes include… more
- Sharp HealthCare (San Diego, CA)
- …Management (ICM) team the Utilization Manager (UM) II position supports utilization review functions to ensure appropriate patient status before the patient ... while ensuring compliance with all local, state and federal regulations governing utilization review activities and/or care management. Expected outcomes include… 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
- Alameda Health System (Oakland, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... information in the AHS financial system; works closely with Revenue Cycle to ensure each inpatient encounter is accurate;...staff. 8. Per the direction and delegation of the Utilization Management social worker and/or nurse , facilitates,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... for the following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Medical Mutual of Ohio (OH)
- …at home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Founded in 1934, Medical ... stay and level of care + Extrapolates and summarizes medical information for physician review or other external review + Generates appropriate written status of … more
- CenterWell (North Charleston, SC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... Branch Director and Company Finance Department to establish location's revenue and budget goals. + Participates in sales and...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Trinity Health (Melrose Park, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Nurse Manager of our Emergency Department at Gottlieb Memorial Hospital is a registered ... professional nurse , conversant with the nursing process, who has 24x7...projects and research activities (as appropriate). a) Conduct bi-annual review of all unit-specific policies/procedures to ensure compliance with… more
- HCA Healthcare (San Antonio, TX)
- …Center have the opportunity to make a real impact. As an Operating Room Nurse you can be a part of change. **Benefits** Methodist Ambulatory Surgery-Medical Center, ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Kissimmee, FL)
- …apart from any other healthcare provider. We are seeking an Operating Room Nurse to join our healthcare family. **Benefits** Kissimmee Surgery Center, offers a total ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Brandon, FL)
- …satisfaction and personal growth, we encourage you to apply for our Operating Room Nurse PRN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as an Operating Room Nurse you want with your current employer? We have...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Dallas, TX)
- …satisfaction and personal growth, we encourage you to apply for our OR Registered Nurse PRN opening. We review all applications. Qualified candidates will be ... you have the career opportunities as a OR Registered Nurse PRN you want with your current employer? We...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Select Medical (Los Angeles, CA)
- …+ Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure positive fiscal ... City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 - $58.65 depends… more