- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... utilization reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance with industry… more
- Novo Nordisk Inc. (Minneapolis, MN)
- …relationships include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, diabetes educators, pharmacists, blood bank staff , ... providers and IHNs; c) develops appropriate use of NNI products and greater utilization of its services d) supports and assists representatives and managers in… more
- Yale New Haven Health (West Haven, CT)
- …Provides Educational Opportunities And Documents Outcomes. Functions As A Preceptor To New Staff . Functions As A Charge Nurse . Meets Performance Expectations For ... Customer Service, Teamwork, Resource Utilization , And Staff And Self Development As...Staff And Self Development As Outlined In Performance Review . Performs Other Duties As Assigned Or Directed To… more
- Yale New Haven Health (Danbury, CT)
- …Provides Educational Opportunities And Documents Outcomes. Functions As A Preceptor To New Staff . Functions As A Charge Nurse . Meets Performance Expectations For ... Customer Service, Teamwork, Resource Utilization , And Staff And Self Development As...Staff And Self Development As Outlined In Performance Review . Performs Other Duties As Assigned Or Directed To… more
- Fresenius Medical Care (Fayetteville, NC)
- …to make daily decisions to ensure continuity of care and patient and staff safety PRINCIPAL DUTIES AND RESPONSIBILITIES: Manages the tactical execution of short- and ... policies and procedures are communicated to and implemented by the facility staff . Maintains integrity of medical records and other FMS administrative and… more
- Fresenius Medical Care (Ponca City, OK)
- …auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials ... including efficient utilization of supplies or equipment and regular profits and loss review . Responsible for all required network reporting and on-site state or… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Nurse issued by the State of Minnesota. **Title:** * Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* ... **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a* Staff Nurse *to join our Utilization ...may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse … 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...new or revised procedures. + Works with Professional Standards Review Organization representative to orient new staff … more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251119-5613FP-001 Location Middletown, CT Date Opened 12/11/2025 12:00:00 AM ... Campus Hospital (https://portal.ct.gov/dcf/solnit-center/south) - is accepting applications for a 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 ... medical direction, administrative and technical supervision over the nursing staff engaged in utilization review ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... acute care indicators and criteria as approved by medical staff , payer guidelines, CMS, and other state agencies. In...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Emory Healthcare/Emory University (Decatur, GA)
- …development _,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / ... be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an...department. This will consist of regular audits of each staff member which will assist with identification in knowledge… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... to infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of… more
- Huron Consulting Group (Chicago, IL)
- …located in Annapolis, MD + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the system, reporting to the ... Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the … 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** + ... excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion,...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... Data gathering requires navigation through multiple system applications. + Staff may be required to contact the providers of...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… 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 ... criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue...level of care.. 5. Collaborates with case managers, nursing staff , coding team , the physicians and finance… more
- Ascension Health (St. Charles, IL)
- **Details** + **Department:** Utilization Review + **Schedule:** Part-Time, Partially Remote, Monday - Friday; 9am - 1pm. + **Hospital:** Ascension Saint Joseph ... Provide health care services regarding admissions, case management, discharge planning, and utilization review . + Review admissions and service requests… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted… more
