- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... **Job Title:** **Registered Nurse UM II** **Location: Columbia SC 29229** **Duration: 3+...member program engagement. + 20% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… more
- Apex Health Solutions (Houston, TX)
- …a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for ... complying with utilization review procedures in accordance with Texas UR Certification requirements,...as part of the preauthorization process; flags cases for review by the Appeals & Outcomes Coordinator … more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate ... timely follow through. | Reviews providers' requests for services and coordinates utilization /appeals management review . | Assist Utilization and Appeals… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …which include Medicare, Commercial, Exchange (Marketplace) and Medicaid. The focus of the UM Pharmacist is to manage the quality, appropriateness, safety and cost of ... medical directors during clinical calls with prescribers. + Presents quarterly CAU review and analysis to the clinical team and compliance department. + Participates… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Radiology Administration has an exciting opportunity for a full time Clinical Program Coordinator to work at Desai Sethi Medical Center in Miami. The incumbent… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Radiology Administration has an exciting opportunity for a full time Clinical Program Coordinator to work at Desai Sethi Medical Center in Miami. The incumbent… more
- Dignity Health (Santa Cruz, CA)
- …pertaining to their practice. 13. Performs other duties as assigned, including utilization review as necessary. _The job summary and responsibilities listed ... excellence. \#RN@DH **Responsibilities** **Job Summary / Purpose** The RN Care Coordinator is responsible for overseeing the progression of care and discharge… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... One Community. One Mission. One California **Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge… more
- Virginia Mason Franciscan Health (Federal Way, WA)
- …to their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Education and Experience** Required ... Sign on Bonus available! **Responsibilities** **JOB SUMMARY / PURPOSE** The Care Coordinator RN is responsible for overseeing the progression of care and discharge… more
- Virginia Mason Franciscan Health (Gig Harbor, WA)
- …to their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Education and Experience** Required ... bonus eligibility, and more! **Responsibilities** **JOB SUMMARY / PURPOSE** The Care Coordinator RN is responsible for overseeing the progression of care and… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... Visit https://www.dignityhealth.org/socal/locations/californiahospital for more information. **Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care… more
- Dignity Health (Sacramento, CA)
- …while striving to achieve high levels of patient satisfaction. The RN Care Coordinator consistently conducts the utilization review process and the ... One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV) **Responsibilities** **Position Summary:** The RN Care Coordinator is responsible for assessing planning facilitating and advocating… more
- Dignity Health (Woodland, CA)
- …while striving to achieve high levels of patient satisfaction. The RN Care Coordinator consistently conducts the utilization review process and the ... One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV) **Responsibilities** The RN Care Coordinator is responsible for assessing planning facilitating and advocating… more
- University of Miami (Miami, FL)
- …+ Troubleshoots insurance and financial concerns with the care team (CIV, utilization review , and CBO) + Participates in quality improvement ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
- Corewell Health (Trenton, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Bassett Healthcare (Cooperstown, NY)
- …a principle liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed ... with medical staff regarding status, placement, payor requirements, and utilization of resources. Identifies patient for readmission risk and...status and level of care matches order. Collaborates with UM Nurse to assure that all payor and status… more
- UCLA Health (Los Angeles, CA)
- …experience (ie, MSO, IPA, or health plan) required + Working knowledge of utilization review /referral processing systems (ie, EPIC) + Working knowledge of CPT-4, ... Description The Appeals & Grievance Intake Coordinator serves as the primary point of contact...direction from the Medical Director and QM Manager. + Review all member appeals and grievances for accuracy, ensuring… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Hussman ... Institute has an exciting opportunity for a full time Clinical Research Coordinator 2 position. The incumbent serves as a mid-level clinical research professional… more
- University of Miami (Miami, FL)
- …Troubleshoots insurance and financial concerns with the care team (CIV, utilization review , and CBO)17. Participates in quality improvement ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more