- ERP International (Luke AFB, AZ)
- … Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management ** in support of...and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case… more
- TEKsystems (Charlotte, NC)
- …8 AM-5 PM CST Quality Assurance Responsibilities: + Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews. ... and specifications are followed and all questions addressed. + Verify each review is supported by current clinical citations and references from reputable medical… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… more
- System One (Baltimore, MD)
- …+ Minimum 5 years clinical experience (acute care preferred) + Previous case management , discharge planning, or utilization review experience + EMR ... Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224 Type: Contract, 5 mos with chance of extension Compensation: Based on experience starting… more
- Ventura County (Ventura, CA)
- …candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of experience ... evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards… more
- CVS Health (Springfield, IL)
- …Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources ... frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management … more
- ChenMed (Houston, TX)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more
- Actalent (Sacramento, CA)
- …experience (eg, med-surg, telemetry, ICU) . At least 1 year of experience in utilization review , case management , or hospital discharge planning . ... LVN- Hybrid Job Duties: . Perform timely utilization reviews for Medicare inpatient admissions, continued stays,...Conduct in-person hospital rounds 2-3 days per week, telephonic review and participate in interdisciplinary case reviews . Escalate… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Case Management . + Determines appropriate care level and resource utilization for complex cases. + Facilitates discharge planning and evaluates alternative ... educator, Pediatric Nursing, Gerontological Nursing, Maternity Nursing, Population health, Disease Management . + Current licensed Registered Nurse (RN) with… more
- WellSpan Health (Chambersburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation… more