- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the… more
- Trinity Health (Dubuque, IA)
- …program + Develops a quality improvement plan utilizing the trauma registry and concurrent patient review + Addresses quality issues with nurses, physicians and ... Family! We are looking to hire a Trauma Coordinator, RN in our Emergency Department! **SCHEDULE:** + Full Time...other departments as needed (eg, Shared Services for contract review ) + Works with Stroke Coordinator to improve pre-hospital… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National certification ... *_SUMMARY:_* We are currently seeking a*Utilization Review Manager* to join ourTransitional Care Team.This is...and implements process to manage and respond to all concurrent and post-discharge third party payer denials of outpatient… more
- BayCare Health System (St. Petersburg, FL)
- …Utilization Management or 6 years of clinical nursing **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + ... respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + Directing and coordinating the daily operations… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...information to the department head as indicated. + Utilization review and utilization managementThe RN CM I… more
- Sharp HealthCare (San Diego, CA)
- …BBS Licensed Marriage and Family Therapist (LMFT) - CA Board of Behavioral Sciences; California Registered Nurse ( RN ) - CA Board of Registered Nursing ... business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs...BLS Healthcare) - American Heart Association -REQUIRED + California Registered Nurse ( RN ) - CA… more
- Sacramento County (Sacramento, CA)
- …Psychiatrist, Psychologist, Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating ... a Psychiatrist, Psychologist, Licensed Clinical Social Worker, Marriage Family Therapist, or Registered Nurse . Note: Failure to maintain a required license may… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... level of care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process,… more
- CareFirst (Baltimore, MD)
- …Onsite Clinical Navigator ( RN ) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth ... care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with...to change based on evolving business needs. **Licenses/Certifications** : RN - Registered Nurse -… more
- Penn State Health (Camp Hill, PA)
- …Contribute to the planning of Stroke Oversight Team meetings. MINIMUM QUALIFICATION(S): + Registered nurse with a bachelor's degree required. + Minimum three (3) ... patients for inclusion in stroke database. + Facilitate chart review , both concurrent and retrospective. + Collaborate...nursing required. + Currently licensed to practice as a registered nurse by state of employment or… more