- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an onsite ... match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and supporting… more
- CVS Health (Columbus, OH)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you'll ... specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management ...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... role in collaborating with our Medical Director to perform benefit and medical necessity reviews and...we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a… more
- Integra Partners (Troy, MI)
- … Director ) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + ... external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly...expectations and functions of the UM team + Time Management What will you achieve in the first 12… more
- Community Health Systems (Franklin, TN)
- …preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations. ... Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- Billings Clinic (Billings, MT)
- …team; if unsuccessful or unable to resolve issues, escalates to Supervisor, Manager, or Director * Insurance and Utilization Management * Maintains working ... service care manager staff provide services consisting of comprehensive case management , care coordination, continuing care services, and clinical social work… more
- University of Utah Health (Salt Lake City, UT)
- …trust that are integral to our mission. EO/AA_ + The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including ... Timekeeping team. + Collaborating closely with Nursing Leadership, the Staff Utilization Coordinator reviews and develops schedules based on agreed-upon staffing… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of our hospital. Overview To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal ... of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient… more
- George C. Grape Community Hospital (Hamburg, IA)
- …* Education & Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and infection control standards. o Serve ... of clinical nursing experience (acute care preferred). o Prior experience in utilization review, case management , quality improvement, and infection control… more