- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for the… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, cost‑effective ... clinical information when needed + Support denial management, including appeals and peer‑to‑peer review processes + Ensure...to case management as appropriate Qualifications + Active CA RN license in good standing + 2-3 years of… more
- International Medical Group (Indianapolis, IN)
- …or tasks as assigned. QUALIFICATIONS + Current and active Nursing license - Registered Nurse + Minimum two years acute hospital-based experience providing direct ... creating the best experience for travelers. JOB DETAILS + RN License -- Must have an active RN...of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review , denials, appeals and reconsideration hearings. Works closely with the… more
- Texas Health Resources (Arlington, TX)
- …management growth inclusive of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW ... staff adoption of workplace changes. Directs the activities of the Care Transition Managers ( RN & SW). Serves as a content expert on the following: Compliance with… more
- Texas Health Resources (Frisco, TX)
- …management growth inclusive of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW ... with outpatient care management. Directs the activities of the Care Transition Managers ( RN & SW). Serves as a content expert on the following: Compliance with… more
- Sacramento County (Sacramento, CA)
- …Employment Qualifications Minimum Qualifications Possession of a current valid license as a Registered Nurse and a Nurse Practitioner certification issued by ... improperly rejected may request the Employment Services Division to review its decision to reject the application. If the...must submit a copy of both my current valid Registered Nurse license AND my Nurse… more
- Presbyterian Homes and Services (Roseville, MN)
- …communicate at IDT + Site specific education + Key measure management Qualifications + Registered nurse with current licensure from the State Board of Nursing in ... end splits + Reviewing all expedited appeals and ALJ level appeals + Monthly QI/QM review for assigned region and provide recommendations to IDT and MDS +… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... The Utilization Review Coordinator conducts utilization reviews to determine if...denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal… more
- System One (Las Vegas, NV)
- …medical criteria and standards of care Licensure and Certification: + Current, unrestricted Registered Nurse ( RN ), Licensed Social Worker (LSW), or Licensed ... and promotes effective utilization of long-term services and supports through clinical review and benefits management. Essential Functions: + Serve as point of… more
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