- Evolent (Oklahoma City, OK)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... Position Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems....departments, and others whose support is necessary for the management and success for the program. . Serves as… more
- Independent Health (Buffalo, NY)
- …credentials preferred. + Four (4) years of clinical experience required. Utilization Management experience preferred. + Comprehensive knowledge and experience ... The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in… more
- The County of Los Angeles (Los Angeles, CA)
- …may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge is ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...of Los Angeles, a Utilization Review Nurse is an RN that has Case Management … more
- Lincoln Financial (Columbia, SC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more **Description** We're seeking an **Inpatient Registry Utilization Review Nurse (PRN)** who is responsible for conducting ... with the attending physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and comprehensive review … more
- Dayton Children's Hospital (Dayton, OH)
- …timeHours:40Job Details:Under the supervision of the Manager of Utilization Management , the Utilization Review RN conducts medical record ... guidelines and communicates information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource to the physicians,… more
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