- Marion County (Salem, OR)
- …initiate authorization process for requests for Long-Term Psychiatric Care.Ensure accuracy of utilization data of those admitted to the Oregon State Hospital and ... Ensure residential capacity, track referrals, placements, placement/discharge dates, and utilization data is being tracked by Choice team. Provide clinical… more
- McLaren Health Care (Bay City, MI)
- …management to expedite patient discharge. 4. Maintains current knowledge of hospital utilization review processes and participates in the resolution of ... Summary_** **:** In conjunction with the admitting/attending physician, the UR Specialist RN assists in determining the appropriate admission status based on… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding ... and compassionate team. **The Utilization Review Specialist Senior responsibilities...Emergency Nursing RN. **Certifications and Licensures:** + Required RN ( Registered Nurse) + Preferred ACM (Case Management) + Preferred… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Corewell Health (Caledonia, MI)
- …continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides ... financial and utilization management (UM) information to other members of the...preferably multiple clinical settings, or related experience Required + Registered Nurse (RN) State of Michigan required Primary Location… more
- Cleveland Clinic (Stuart, FL)
- …nurses, and other caregivers in a family-oriented, supportive environment. As a PRN Utilization Management (UM) Specialist , you will perform UM activities, such ... as admission review , concurrent review , retrospective chart ...Requires three years equivalent full-time clinical experience as a Registered Nurse. + Prior Utilization Management experience… 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 Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Cleveland Clinic (Weston, FL)
- …Miami-Fort Lauderdale metro area and remains a top hospital in Florida. As a Utilization Management (UM) Specialist , you will work under the general supervision ... of the UM Team Manager to perform UM activities which include admission review , concurrent review , retrospective chart review and clinical systems review … more
- University of Washington (Seattle, WA)
- …partial/variable involvement with Harborview's Emergency Department. The Utilization Management Specialist RN2 is responsible for the ongoing review of a ... benefits for this position, click here (https://hr.uw.edu/benefits/wp-content/uploads/sites/3/2018/02/benefits-summary-classified-staff-greater-than-half-time-20220908\_a11y.pdf) . RN2, Utilization Management Specialist . This is a hybrid… more
- Sanford Health (SD)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- New York State Civil Service (Wallkill, NY)
- …years of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning. Substitution: a bachelor's degree in ... Yes Agency Corrections and Community Supervision, Department of Title Registered Nurse 2 - Utilization (NY HELPS)...to verify your identity. Name Katrina Truax, Human Resources Specialist 1 Telephone ### Fax ### Email Address ###@doccs.ny.gov… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Accreditation and Quality (A&Q) Nurse Specialist demonstrates leadership in providing continuous readiness for accreditation and regulatory agency ... review and compliance (Joint Commission, Inspector General, Long Term...rewards package: VA Nurse Total Rewards The A&Q Nurse Specialist reports directly Chief of Quality. He/she is accountable… more
- Katmai (Usaf Academy, CO)
- …for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Trinity Health (Livonia, MI)
- …**Description:** Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist - REMOTE **Trinity Health at Home is seeking an ... experienced RN Clinical Quality Review Specialist - REMOTE** **Position Summary** The...accurate documentation and plan of care development including visit utilization targets and identification of hospitalization risk to produce… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- SSM Health (St. Louis, MO)
- …pharmaceutical care in their specialty practice area which may include: review and evaluation of patient drug/medical history, providing drug therapy recommendations ... evaluating medical literature, rounding with other healthcare providers, drug utilization reviews, patient counseling and order entry/verification/dispensing. + Plans,… more
- Sharp HealthCare (San Diego, CA)
- …Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; ServSafe Food ... excellent evidence-based quality of services, and assuring timely and accurate quality review in compliance with the hospice and palliative care quality/safety plan.… more
- Henry Ford Health System (Bingham Farms, MI)
- …of pharmacy services, decrease waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental in guiding the further ... GENERAL SUMMARY: The Pharmacy Specialist provides oversight and leadership for appropriate drug...provided by the primary care team. He/she works with utilization management reports, corporate data stores, and information services… more
- Louisiana Department of State Civil Service (New Orleans, LA)
- ADULT PROTECTION SPECIALIST 1 - 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4565726) Apply ADULT PROTECTION SPECIALIST 1 - 3 Salary ... of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner. LDH serves as a… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands ... utilization review and coverage guidelines for multiple payers; + Identifies...and reviews findings with all levels of Payment Resolution Specialist for further review . Serve as a… more
