- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... **Overview** The Senior Utilization Review Specialist collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... **Overview** The Utilization Review Physician collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- Prime Healthcare (Ontario, CA)
- …or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + An ... strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with facility-based case … more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review / case management/ clinical /or combination; ... independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is… more
- Actalent (Remote, OR)
- …meet client/customer needs. Skills nurse, RN, Utilization management, Utilization review , Case management, Clinical review , Care management, ... medical terminology, disease process Top Skills Details nurse,RN, Utilization management, Utilization review , Case management, Clinical review… more
- BayCare Health System (Tampa, FL)
- … in the acute care setting through collegial interaction with Utilization Review , Case Management, and Clinical Providers while aligning with ... Cerner Secondary Reviews in a timely fashion with appropriate documentation allowing Utilization Review Nurses to efficiently execute Secondary Review … more
- Pacific Medical Centers (Renton, WA)
- …Registered Nurse License. + 5 years Clinical experience. + Utilization review / case management. **Preferred Qualifications:** + Bachelor's Degree ... to assure cost effective, appropriate utilization of health care resource. Utilization Nurse / Case Manager manages, directs, and coordinates the entire… more
- Alight (NJ)
- …health, worker compensation, disability, health case management, or utilization review . + 2+ years as a Clinical Case Manager. Additionally, ... careers.alight.com (https://careers.alight.com/us/en) . **About the Role** This role will provide clinical expertise and serve as a critical link between all parties… more
- Lawrence General Hospital (Lawrence, MA)
- …care, care management, and utilization review . + Five years clinical nursing experience required + Case Management Essentials - Certificate Program, must ... The Utilization Review Coordinator functions as the...Coordinator is responsible for oversight of UR and ED Case Managers and will assist with the programmatic management… more
- Beth Israel Lahey Health (Burlington, MA)
- …just taking a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient ... the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg… more
- Baptist Memorial (Jackson, MS)
- …+ Employee referral program Job Summary: Position: 19738 - RN- Utilization Review Facility: MBMC - Hospital Department: HS Case Mgmt Administration Corporate ... Summary The Utilization Review Nurse is responsible for...against standard criteria per payer guidelines + Prioritizes observation case review + Assists with level of… more
- AdventHealth (Altamonte Springs, FL)
- …in any field of study . Experience in denial management, utilization review , case management, clinical documentation improvement, revenue integrity, or ... have at least an Associate's Degree in Nursing) . Utilization Review / Utilization Management experience of...related field . Certification in Case Management (ACMA/CCM) . Certification Clinical Documentation… more
- UCLA Health (Los Angeles, CA)
- …for assessing and coordinating care for a diverse group of patients. This in-patient utilization review case manager position will work on-site at our ... coordination of care. In this role you will perform utilization review while assuring the delivery of...RN License and BLS certification + Recent experience in case management, utilization management and discharge planning… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if...the event a facility does not have an ED Case Manager present, the UR Clinical Specialist… more
- Trinity Health (Lavonia, GA)
- …3 years experience in nursing in a hospital setting; preferred 1 year in case management, utilization management, or discharge planning . Required Skills and ... **Employment Type:** Full time **Shift:** **Description:** The RN Case Manager (RN CM), works in collaboration with a multidisciplinary team by identifying and… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …requested clinical and psychosocial information to assure reimbursement. UTILIZATION REVIEW + Reviews prospectively, concurrently and retrospectively all ... resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the clinical team, service… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …preferred. * Experience: A minimum of two years of clinical experience in Utilization Review or Case Management is preferred. * Per Diem Positions: ... experience and internal equity. Position Summary: * Reports to the Director of Case Management * Plan, organize and deliver utilization management activities for… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189319/ case -manager%2c-rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager… more
- UNC Health Care (Raleigh, NC)
- …base tasks, or other electronic communication and via telephone. Responsibilities: 1. Clinical Review Process - Uses approved criteria and conducts admission ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical ... review /status change review within 24 hours of… more
- Dignity Health (Stockton, CA)
- …outside therapists community agencies and significant others. Under supervision of the case manager and manager of clinical services performs psychosocial ... that fosters communication trust and personal growth. **Responsibilities** **Position Summary:** Case Manager 1 assists Case Managers in coordinating and… more