- Providence (Mission Hills, CA)
- …must empower them. **Required Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience working ... Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of… more
- US Tech Solutions (Columbia, SC)
- …**Duration: 3+ Months Contract (Possible temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted SC RN license. + ... promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …internal providers, and community partners to promote seamless, coordinated care. Apply utilization review criteria and evidence-based standards to ensure safe, ... applicants will be reviewed and referred to the hiring manager on a weekly basis. **This position is eligible...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Saint Francis Health System (OK)
- …their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers ... reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... stay reviews to assure hospitalizations meet payor requirements. Maintains records of review information and outcomes for billing purposes and for compliance with… more
- Eastern Connecticut Health Network (Manchester, CT)
- POSITION SUMMARY: The Utilization Review Case Manager ...or a related field. + Current licensure as an RN . EXPERIENCE: + 2 - 3 years' experience in ... in the acute-care setting. + Minimum of 1 year Utilization Review experience preferred via industry clinical...and status on all patients through collaboration with Case Manager . + Demonstrates thorough knowledge in the application of… more
- Mohawk Valley Health System (Utica, NY)
- …care to our diverse member population. Provides direct oversight of the case manager 's daily operations of utilization review practice, processes and ... RN Supervisor Case Management - Full Time -...Performs related duties as assigned. Education/Experience Requirements REQUIRED: + Registered Nurse licensed in State of New… more
- Amergis (Santa Rosa, CA)
- The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service ... delivery, and compliance with medical regime. Minimum Requirements: + Current RN licensure in state practicing + At least one year of Case Management experience… 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 Clinical Utilization Review Specialist is responsible for...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more