- CommonSpirit Health (Centennial, CO)
- …as a Registered Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial appeal letters ... indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process… more
- Northwell Health (Manhasset, NY)
- …team and provide pharmacy recommendations + Education and development of nurse , physician and pharmacy staff development pertaining to transplant and ... and research. + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, and… more
- Mohawk Valley Health System (Utica, NY)
- …scheduling records. + Participates in agency meetings and the quality improvement and utilization review activities of the organization. + Follows all state, ... electronic scheduling of all clinical disciplines of the Visiting Nurse Association of Utica and Oneida County, Inc. (VNA)....Participates in agency meetings and the quality improvement and utilization review activities of the organization. +… more
- UnityPoint Health (Cedar Rapids, IA)
- …home care. Responsible for case coordination of patients and insurance precertification/ utilization review . Patients served include adult and geriatric. St. ... coverage. + Coordinates cases with community agencies, referral sources. + Manages utilization review for own patients with insurance carriers. + Provides… more
- HCA Healthcare (Wichita, KS)
- …or 2 years of critical care experience is preferred + Certification in case management or utilization review is preferred + InterQual experience is ... When you work as an RN for our Case Management Team, you are joining an elite team of...Licensure in the State of Kansas as a Registered Nurse (RN) or Current Multi-State Licensure as a Registered… more
- Trevecca Center for Rehabilitation and Healing (Nashville, TN)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... the administrator in development of the annual budget. Appropriate and effective utilization of staff. Managing key operations and financial levers to achieve budget… more
- Eastern Connecticut Health Network (Manchester, CT)
- …experience in a medical surgical acute care setting + Additional experience in case management , home care, and utilization review / management is ... hospital as needed. Reports to the Manager of Care Management . EDUCATION/CERTIFICATION + Graduate of an accredited school of...+ Must have a current license as a Registered Nurse in the State of Connecticut . + Professional… more
- Cleveland Clinic (Weston, FL)
- …to ensure compliance and strong performance across safety, quality, utilization and patient experience metrics and support implementation of requirements ... compliance with all standards and favorable performance on safety, quality, utilization , and experience metrics. + Participate in engraining the safety, quality,… more
- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... appropriate to the age of the patient treated. + Performs admission review on all inpatients. Attends daily patient rounds and shares professional knowledge,… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... the enhanced Nurse Licensure Compact (eNLC). + Nationally recognized Case Management Certification within 5 years of start date. + Critical thinking and problem… more