- St. Peters Health (Helena, MT)
- …providers is an essential requirement for this role. EDUCATION: * Clinical preparation; RN required LICENSE/CERTIFICATION/REGISTRY: Nursing licensure in the ... The Utilization Management RN reports directly to Utilization Review RN...admission status and confirm treatment goals, treatment plan, and clinical mileposts used to advance the treatment plan. 12.… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …care coordination, and transition of care between settings. Required Skills and Experience * Registered nurse with current MN license and with no restrictions. * ... Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services About Blue Cross… more
- Select Medical (Harrisburg, PA)
- …and valid state licensure or eligibility for state licensure as a Registered Nurse , Physical Therapist, Occupational Therapist, or Speech Language Pathologist ... **Overview** **Hospital Name: Central PA Neuro Transitional Center** **Position:** ** Clinical Liaison ( RN , OT, PT, or SLP)** **Location: Harrisburg, PA**… more
- CommonSpirit Health (Westminster, CO)
- … Clinical Career Ladder to help you grow and recognize your contributions to clinical excellence! As a Nurse with us you will assume responsibility and ... external applicants with at least six months of direct RN experience are eligible for a $20,000 sign-on bonus!**...care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as… more
- University of Southern California (Arcadia, CA)
- …of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing ... process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts and serving as a clinical resource for… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- UnityPoint Health (Cedar Rapids, IA)
- …of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides ... UM spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD...party payers regarding authorization of stay, continued stay reviews, appeals and denial letters. + Provides education and serves… more
- CVS Health (Baton Rouge, LA)
- …The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to ensure the efficient, compliant, and high-quality delivery of ... NCQA, URAC). + Collaborate with internal and external stakeholders-including clinical leadership, operations, IT, and regulatory bodies-to align utilization… more
- Beth Israel Lahey Health (Plymouth, MA)
- …and determines appropriate strategy in response to reimbursement denials. + Responsible for appeals and follow up on clinical denials escalated through a work ... queue, providing appropriate response supported by clinical information. + Provides oversight of the appeals process and direction regarding appeals and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Peer Review Specialist works closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk ... and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + Physician… more