- Prime Healthcare (Gadsden, AL)
- …communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use ... with CMO (Chief Medical Officer). Actively participates in the Case management and UR meetings. Serves as on-going educator...or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical Review Coordinator… more
- Providence (Tarzana, CA)
- **Description** **Peer Review RN to join our Risk Management team at Providence Tarzana Medical Center in Tarzana, CA. This position is full-time and will work day ... shifts.** The Peer Review RN is responsible for facilitating the design, implementation...other reports and databases as well as perform needed case reviews based on Federal, State and National guidelines.… more
- Actalent (Tigard, OR)
- …+ Understanding of utilization management processes preferred. + Proficient in clinical review , case management, and concurrent review . Job Description ... Job Title: Clinical Review Nurse - Concurrent Review Work Environment + This is a 100% remote position + The schedule is Tuesday to Saturday, 10 AM to 7 PM PST.… more
- Virtua Health (Pennsauken, NJ)
- …resource group and payers.Documentation* Appropriate and complete documentation of clinical review and denial management in the case management documentation ... from the State of New Jersey as a Registered Nurse. Case Management Certification (requirement within one year of hire beginning… more
- Medical Mutual of Ohio (OH)
- …and level of care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates appropriate written status of ... explaining processes for accessing health plan to perform clinical review , identifying appropriate community resources, or otherwise interacting with health… more
- Monte Nido (Miami, FL)
- …the opportunity for people to realize their healthy selves. **Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering treatment ... an intimate home setting. We are seeking a Utilization Review Clinician to join our team based Remotely. **This...with billing regarding billing/claims issues and status of single case agreements as needed. + Effectively communicate with program… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At ... Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance regarding UR… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- … case studies for presentation to the Multi-Specialty Peer Review Committee and Section Committees. Performance Improvement: Identify opportunities for provider ... analytical professional passionate about improving patient care through effective peer review processes? Virginia Mason Franciscan Health is seeking a dedicated… more
- HonorHealth (AZ)
- …it does. 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
- Global Foundries (Malta, NY)
- …+ Hosting regular meetings with cross-functional teams. + Governing delegated review boards, ensuring compliance with quality standards and defining customer ... and tracking efficiency and effectiveness through KPIs. + Managing escalation review boards with senior leadership team. + Leading continual improvement activities… more