- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Community Health Systems (Franklin, TN)
- …appeals activities, and collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review Specialist monitors ... 2-4 years of clinical experience in utilization review , case management, or acute care nursing...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more
- Tenet Healthcare (Detroit, MI)
- …appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily, essential) ... RN Utilization Review - Case Management -...coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced… more
- Ochsner Health (Jefferson, LA)
- …relationships, contract management, standardization and consolidation processes and utilization analysis. Reviews, analyzes, negotiates, and develops contractual ... cost reduction initiatives throughout the organization by serving as a project manager and consultant to the clinical and non-clinical areas; tracks the system… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... to monitor appropriateness of admissions with associated levels of care and continued stay review . + Communication...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Elevance Health (Tampa, FL)
- …health practitioners responsible for coordinating member service, utilization , access, care management and/or concurrent review to ensure cost effective ... law. *Must reside in the state of Florida* The ** Manager of Utilization Management** is responsible for...+ MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred. + Certified Case Manager … more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines...Case Manager (ACM-RN), or UM Certification + Utilization Review experience **Where You'll Work** Hello… more
- LA Care Health Plan (Los Angeles, CA)
- … Management Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination ... Utilization Management Admissions Liaison RN II Job Category:...participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote. This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and concurrent ... utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... the purpose of obtaining or relaying information regarding the review process. Coordinates the care of patients...relate to the working DRG developed by the Case Manager /Coder. Assists with special projects as directed or requested… more