- TalentBurst, Inc (Irving, TX)
- …criteria in order to determine appropriate level of care * Resource/ Utilization Management appropriateness: Assess assigned patient population for medical ... with tax-free stipend amount to be determined. Posted job title: Registered Nurse Utilization Review \ 1366About TalentBurst, IncTalentBurst Health & Life… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... assigned at any time with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level… more
- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily...documents, and codes and reports the data to the Utilization Management Inpatient Coordinator and Inpatient Nurses.13.… more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Actalent (Houston, TX)
- …+ MINIMUM 2 years clinical experience in a clinical setting + Experienced in Utilization Management and knowledge of URAC & NCQA standards + Broad knowledge ... care organization on a Sunday to Thursday OR Tuesday to Saturday basis doing utilization review for PAC patients. Interviews are being set up quickly with equipment… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- McLaren Health Care (Detroit, MI)
- …**Essential Functions and Responsibilities as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... **Department: Utilization Management ** **Daily Work Times: 9:00am-5:30pm**...to support the level of care being billed. Conducts concurrent reviews to ensure criteria for patient status and… more
- McLaren Health Care (Detroit, MI)
- …**Essential Functions and Responsibilities as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...support the level of care being billed . Conducts concurrent reviews to ensure criteria for patient status and… more
- AdventHealth (Tampa, FL)
- …strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated patient ... **The rol** **e you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ...through accordingly to prevent loss of reimbursement, including the management of concurrent and pre-bill denials. .… more
- Health First (Melbourne, FL)
- …vehicle. **Job:** **Case Management * **Organization:** **Holmes Regional Medical Center* **Title:** * Utilization Review Nurse - Case Management UR Part ... *POSITION SUMMARY* The Utilization Review (UR) nurse performs medical...as necessary. 7. Is an active member of the Utilization Management Committee. *MINIMUM QUALIFICATIONS* *Education:*Associate's Degree… more
- Beth Israel Lahey Health (Needham, MA)
- …**Job Description:** **Essential Functions and Responsibilities:** Performs a variety of concurrent and retrospective utilization management -related reviews ... payer certification, and denied cases. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- Beth Israel Lahey Health (Burlington, MA)
- …identifies delays. **Essential Functions and Responsibilities:** Performs a variety of concurrent and retrospective utilization management -related reviews ... payer certification, and denied cases. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- University of Virginia (Charlottesville, VA)
- …conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission ... Under general direction: The Utilization Management RN serves as a...hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. PREFERRED REQUIREMENTS… more
- University of Virginia (Charlottesville, VA)
- …conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission ... Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management … more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... **REQUIREMENTS** None. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** Full Time, 40 hours weekly, Monday - Friday 7:30am - 4pm + **Hospital:** Ascension Via ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Intermountain Health (Murray, UT)
- …practice. + Three years clinical nursing experience. + One year in Managed Care, Utilization Management , or Case Management . + Basic computer skills ... knowledge of Medicare, Medicaid and Commercial insurance. + Current working knowledge of utilization management and case management techniques. + Working… more
- Actalent (Kansas City, KS)
- Job Title: Utilization Review - Post Acute Care Job Description Our...of care management + Length of stay management + Concurrent Review Job Type This is ... PAC Nurse is a telephonic role responsible for recommending discharge...assigned and non-assigned post-acute care (PAC) facilities. The PAC Nurse will collaborate with key facility personnel and internal… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s) ... development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... in Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN)...Degree in a health related field + 3 Years Utilization Management or case management … more
