- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - ... class as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial… more
- US Tech Solutions (Columbia, SC)
- …sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy experience + A typical ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management/ clinical /or combination; 2 of 4 years… more
- Monroe County, NY (Rochester, NY)
- …The employee reports directly to, and works under the general supervision of a Nurse Manager , or other higher-level staff member. General supervision may be ... Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit,...for providing nursing care that may include bedside and/or clinical care to convalescent, chronically ill, and seriously ill… more
- CenterWell (Augusta, ME)
- …or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, ... Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning and monitors quality assurance for Lahey… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Experience in HEDIS, MIPS, PQRS, ACO, STARS preferred… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more