- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered ... for case management scope of services including: Utilization Management services supporting medical necessity and...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- TEKsystems (Los Angeles, CA)
- …Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... Job Title: Retro Claims Reviewer Location: West Hills/Canoga Park 91305 Compensation: LVN...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to… more
- Community Health Systems (Naples, FL)
- …401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, ... Join us as a **Registered Nurse (RN) - Utilization Review...tools. + Collaborates with providers, care teams, and case management to ensure appropriate documentation, clinical justification, and status… more
- Elevance Health (West Des Moines, IA)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles referrals for specialty ... ** Utilization Management Representative II** **Location:** The...+ Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- Elevance Health (Indianapolis, IN)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... **Title: Utilization Management Representative I** **Virtual:** This...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Elevance Health (Costa Mesa, CA)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... ** Utilization Management Representative I** **Location** :...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or...confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center - M-F, 8:00 AM - 5:00 PM **Webster, Texas, United States** Nursing & Care Management UTMB Health ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more