- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote. This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and concurrent ... strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The… more
- Baylor Scott & White Health (Dallas, TX)
- …creating a solution to their issues. Knowledge and use of discharge planning, case management referral criteria, utilization review and levels of care. ... **JOB SUMMARY** The Utilization Review Registered Nurse (RN) provides...Identifies, documents and communicates potential quality assurance or risk management issues as appropriate. Participates in process improvement projects,… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... Under the direction of the Case Management Coordinator, coordinates, negotiates, procures and manages the...to assure hospitalizations meet payor requirements. Maintains records of review information and outcomes for billing purposes and for… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... + Required RN (Registered Nurse) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager ) **Education:**...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue ... Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and… more
- Saint Francis Health System (Tulsa, OK)
- …is not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Tulsa, Oklahoma 74136 ... levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate...participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... of business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement, change adoption… more
- Elevance Health (Durham, NC)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May ... ** Utilization Management Medical Director- NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa,… more