- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... and promotes the efficient and effective use of patient services. The Utilization Review Team's role in data collection, analysis and summarization supports the… more
- UNC Health (Chapel Hill, NC)
- …unique communities we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- UNC Health (Chapel Hill, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...guidelines and policies.Responsibilities:1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new… more
- Aequor (New York, NY)
- …occupational nursing professional Minimum experience of 1-3 years in case management, utilization review and/or quality assurance Experience in episodic care, ... wellness care and counseling of adults Proficiency in use of electronic medical record keeping systems desirable BLS certification required Optional: Case Management and COHN-S certifications Major Responsibilities: Assist in coordination of clinical… more
- University of New Mexico - Hospitals (Algodones, NM)
- This is a Utilization Review position. We review all admissions and continued stay to the hospital for Medical necessity and manage the insurance ... patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE… more
- Spectraforce Technologies (Columbia, SC)
- …Responsibilities: 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews ... guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.… more
- Sentara Health (Hampton, VA)
- …CCCTM, CMAC or CMGT-BC, care management, patient outcome, discharge planning, utilization review , integrated care, flexi, hospital, inpatient, discharge planning ... hours Shift: Days Requirements: Minimum 1 Year - Case Management, Acute Nurse , Nursing Education: - RN: Associate's, Bachelor, RN-Diploma and Master Degree Inpatient… more
- Pathways Vermont (Burlington, VT)
- …Registered Nurse (APRN). Meet weekly for individual supervision, to review role expectations and provide feedbackProvide ongoing support for job completion ... and regularly update program policies and procedures; and participate in review , creation, and updating of agency policiesWork with the Intake Team… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …- Coordinates and facilitate communication between Health Information Management, Utilization Review /Case management, Quality Management, physician leadership to ... to monthly: Multidisciplinary Quality Improvement (MDQI) Committee, Trauma Case Review /Peer Review Committee, Trauma Performance Improvement Committee (TPIC),… more
- University of New Mexico - Hospitals (Algodones, NM)
- …patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE ... FTE: 1.00 Full Time Shift: Days Position Summary: Responsible for the initial review , triage and assignment of patients to case managers and for the coordination… 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 ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization ... requests for services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a team responsible ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 240604-5612FP-002 Location Hartford, CT Date Opened 6/5/2024 12:00:00 AM Salary $76,565 - ... is seeking a highly motivated and compassionate U tilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) to join our team!… more
- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... excelling in this position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- Milford Regional Medical Center (Milford, MA)
- …services to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization ... 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Justice, Bureau of Prisons/Federal Prison System (Fort Worth, TX)
- …Medical Care Level 3 facility, or Federal Correctional Complex (FCC). Serves as the Utilization Review Nurse and assists in quality improvement activities ... to the appropriateness of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and… more
- University of Washington (Seattle, WA)
- …) **UW Medical Center - Northwest** has an outstanding opportunity for an **experienced Utilization Review Nurse ** to join our team. **WORK SCHEDULE** + ... POSITION QUALIFICATIONS** + 3 years of work experience in utilization management + 5 years of nursing work experience...training + Active licensure to practice as a Registered Nurse in Washington State + Knowledge of medical screening… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and...acute care experience is required as a Licensed Practical Nurse . + Minimum of two (2) years Utilization… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …The Role BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
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