- 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
- CenterWell (San Juan, PR)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …preferred, ie, Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), ... normally acquired through completion of a bachelor's degree in Nursing . + Master's Degree required in business, health care.... + Extensive knowledge of payer mechanisms and clinical utilization management is required. + A minimum… more
- Dignity Health (Gilbert, AZ)
- …and Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to ... hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of...+ Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification + Utilization … more
- Trinity Health (Berwyn, IL)
- …are currently looking for an experienced Authorization Referral Coordinator. Reporting to the Manager of Utilization Management and working under general ... the clinical team per protocol. Refers requests to the nurse reviewer or medical director if criteria or guidelines...and assist with in-network referrals. + Escalate requests to nurse reviewers or medical directors when guidelines are not… more
- LifeCenter Northwest (Bellevue, WA)
- …- $159,600.00 Salary Position Type Full Time Description and Qualifications The Manager , Organ Utilization (OUM) provides strategic leadership and operational ... results and identify areas for improvement. + Partner with the Organ Utilization Program Manager (OUPM) on OUCT staffing, onboarding, competency development,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... management and accountability Qualifications + Bachelor's Degree in nursing and + 3-5 years experience + Experience in... and + 3-5 years experience + Experience in Utilization Review + Master's Degree in nursing … more
- Guthrie (Binghamton, NY)
- …State of Pennsylvania/New York. Certification within area of expertise or practice preferred ( Nursing Management , CCRN, CEN, etc.) BSN required within 3 years of ... impact on practice in the planning and delivery of nursing and other services. + Utilizes staffing management...+ Manages daily staffing issues in conjunction with Charge Nurse / Nurse Manager , analyzing… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more