- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring that ... Qualifications + Two years of strong clinical nursing experience, preferably as a floor nurse or in direct patient care. + Experience in utilization management is a… more
- Community Health Systems (Franklin, TN)
- …Monitoring Calls as needed per Director invite **Qualifications** + Required Education: Registered Nurse + Preferred Education: BSN, MSN, Clinical Informatics ... Summary The CM / UR Software Implementation specialist works within the Corporate Case Management department and reports up to the Director of Clinical Data… more
- Beth Israel Lahey Health (Burlington, MA)
- …CCM, ACM highly desirable. Experience: Must have at least 5 years inpatient UR / CM experience Knowledge of payment methodologies, federal and state regulations, ... organization and communication skills required. **Pay Range:** $38.11 - $98.23 The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation… more
- PeaceHealth (Bellingham, WA)
- …Review experience, someone who can talk to providers. **Credentials** + Required: Registered Nurse in state of practice + Preferred: Psychiatric/Mental Health ... off hours and follow-up on payer authorization. + Complete UR Admission review and Concurrent review processes. Ensure best...Ensure delivery of appropriate Medicare Notices. + Assist MSW CM with medical transitions of care discharge planning such… more
- Houston Methodist (Houston, TX)
- …or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must ... for leadership performance, operational benchmarks, and accountability frameworks for hospital CM Directors and Central UR Director. **SERVICE ESSENTIAL… more
- HCA Healthcare (Kansas City, MO)
- …physician to adhere to the self-denial process. **What qualifications you will need:** + (RN) Registered Nurse + Registered Nurse Diploma, or Associate ... optimal care and appropriate resource utilization. + Responsible for ensuring other RN CM in department are using IQ criteria appropriately. + Conduct reviews with… more