- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- AnMed Health (Anderson, SC)
- …This position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These duties ... continued stay/concurrent review, retrospective review, bed status management, resource utilization management, regulatory compliance, and related denial management issues.… more
- UNC Health Care (Hendersonville, NC)
- …health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review cases ... patient's needs are met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the health system's … more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote. This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and concurrent ... utilization reviews for our LA ministries. Conduct clinical reviews...care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal, state,… more
- Dignity Health (Rancho Cordova, CA)
- …is work from home** **within driving distance of Sacramento, CA** **.** As a Utilization Review (UR) LVN, you will use clinical judgement in providing utilization ... work activities. **Job Requirements** **Minimum Qualifications:** - 3 years Managed Care/ Utilization Management (UM) experience. 5 years LVN experience. - Clear and… more
- Penn Medicine (Lancaster, PA)
- …Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for patients by ... thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical records to… more
- Highmark Health (Bismarck, ND)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... the physician against medical policy criteria. The incumbent then uses...prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to… more
- UNC Health Care (Kinston, NC)
- …first and second levels of an audit appeal. Works collaboratively with the Physician Advisors and subject matter experts for all audit and appeals work activities. ... the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria to… more
- Ellis Medicine (Schenectady, NY)
- …schedulers to communicate open time availability + Coordinates operating room schedules with physician availability to maximize utilization of OR time + Displays ... participates in the creation of the daily surgical schedule optimizing block utilization and customer satisfaction, participates in the creation of the pre-admission… more