- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Hospital Description of Duties This position is in the Utilization Review Unit and functions as an...and works under the general supervision of a Nurse Manager , or other higher-level staff member. General supervision may… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time **Shift:** Day ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management, you will be...care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of clinical guidelines ... **Responsibilities** Responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the… more
- Trinity Health (Fort Lauderdale, FL)
- …Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by ... hospital clinical experience is required.** Recent experience in case management, utilization review , discharge planning, ongoing monitoring and evaluation of… more
- Prime Healthcare (Ontario, CA)
- …school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a Health Plan. + At least 3 years of ... experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) certificate upon hire and maintain current. + Knowledge of… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of...care to MCC in response to physician order, or review of updated clinical information Acts as a resource… more
- CareFirst (Baltimore, MD)
- …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care...FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. +… more
- Swedish Health Services (Seattle, WA)
- …considered_** **Care Manager RN** **Per diem / On call** **Day shift** The Utilization Review (UR) Nurse has a strong clinical background blended with a ... well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by… more
- Baptist Memorial (Memphis, TN)
- …and/or life situation. Performs other duties as assigned. Responsibilities + Utilization Review + Discharge planning + Readmission Reduction Participation ... safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer… more