- Elliot Health System (Bedford, NH)
- …collects clinical data in support of quality, risk management, utilization , infection control and resource utilization etc. Participates in multidisciplinary ... plans of care to expedite recovery and discharge of patient. Provides clinical interventions with patients, and families that address personal and environmental… more
- Independent Health (Buffalo, NY)
- …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care setting preferred. +… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization ... and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for ...Utilization Review Nurse is responsible for review of clinical information documented from providers… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for ... is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is preferred. +… more
- Molina Healthcare (Columbus, OH)
- **Job Description** Job Summary Creates and delivers clinical training programs for clinical staff across the enterprise to orient employees to Molina ... clinical methodology, along with policies, processes and systems. Ensures...the development, implementation, and delivery of training curriculum for Utilization Management, Case Management, and LTSS staff. Leads and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …patient population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, ... **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)
- …Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, ... **Overview** The Utilization Review Physician collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- MD Anderson Cancer Center (Houston, TX)
- …to peer or appeals to mitigate denials KEY FUNCTIONS Standards of Practice a₠" Utilization Review Concepts Applies approved clinical criteria and payer ... employees and the public. The primary purpose of the Utilization Review Nurse position is to: Evaluate...receives care Ensure appropriate payment of services that includes review of the appropriate patient class, providing clinical… more
- New York State Civil Service (Queens Village, NY)
- …State NY Zip Code 11427 Duties Description As a Utilization Review Coordinator, your duties will include:* Reviewing clinical records for completeness ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Creedmoor Psychiatric Center, P25684 Occupational Category Health… more
- New York State Civil Service (Bronx, NY)
- …from outside or within State Service can apply.As a Utilization Review Coordinator, your duties will include:* Reviewing clinical records for completeness ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P25595 Occupational… 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 NURSE ... medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records … more
- The Arora Group (Bethesda, MD)
- …LPN certification is required. + Experience: Requires a minimum of 2 years of clinical and utilization review experience or any combination of education ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a...patients and their families and employee satisfaction. + Perform clinical reviews to assess medical necessity of broad range… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ +… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey Clinic inpatient… more
- Intermountain Health (Las Vegas, NV)
- …care organizations, which includes Medicare coverage criteria. **Job Profile:** Performs medical review activities pertaining to utilization review , claims ... Management, you are responsible, in partnership with MG Clinical Leadership, for the appropriate utilization of...review , quality assurance, and medical review of complex, controversial, or experimental medical services. Engages… more
- Intermountain Health (Murray, UT)
- …regulatory requirements. + Occasional travel to provider locations within Select Health region. ** Utilization Review and Care Management:** + ** Review and ... and experience in behavioral health. + Knowledge of healthcare insurance and utilization review processes. + Excellent communication and interpersonal skills. +… more
- Matrix Providers (Aurora, CO)
- …care clinical setting and 12 months consecutive experience in utilization management, utilization review or case management. Licensure/Registration: ... Utilization Review Nurse (RN) Location: Aurora,... Utilization Review Nurse (RN) Location: Aurora, CO, United States...and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to join our… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you...UR and the analysis, resolution, monitoring & reporting of clinical denials. + Maintains current knowledge of payer contract… more
