- Community Health Systems (Franklin, TN)
- …necessity, discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including ... reconsiderations or coordinating peer-to-peer reviews. + Communicates effectively with utilization review coordinators, case managers, and discharge planners to… more
- Trinity Health (Columbus, OH)
- …financial resources in a responsible manner. + Facilitates the provider peer review process including case identification through internal reporting data, ... case summaries for cases that meet the peer review indicator list and sends them to physician reviewers...case discussion and resolution. + Onboards new peer review committee members and department chairs, providing education on… more
- Children's Mercy Kansas City (Kansas City, MO)
- …training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening guidelines, and...days of hire + One of the following: American Case Management, Certified Case Manager required upon… more
- The County of Los Angeles (Los Angeles, CA)
- …squatting. Considerable ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience ... Review Nurse? In the County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that the… more
- Nightwing (Sterling, VA)
- …security and classification is required * Prior client experience is required, but on a case -by- case review of a contractor's resume, the client may decide ... community, defense, civil, and commercial markets. Nightwing seeks part-time Information Review and Release Analysts for our Ft. Meade, Maryland client in… more
- Highmark Health (Pittsburgh, PA)
- …execution of the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the detection and investigation ... Provides daily direction and oversight to management and team leads regarding case investigation activities including the development of detailed strategies for each… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …2 years of recent clinical experience (eg, med/surg, ICU, ED, or case management) * Strong understanding of utilization review /utilization management principles ... require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Utilization Review Manager* to join ourTransitional Care Team.Thisis a full-time role. *Purpose of this position: *Manages ... the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising staff performing… more
- MyFlorida (Fort Pierce, FL)
- OPERATIONS REVIEW SPECIALIST - 60002289 Date: Sep 10, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 860236 Agency: Children and Families Working Title: OPERATIONS REVIEW SPECIALIST - 60002289 Pay Plan: Career Service Position Number: 60002289… more
- HonorHealth (AZ)
- …Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more