- Calvary Hospital (Bronx, NY)
- …year Requirements QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years ... has been denied. Conducts interdepartmental meetings related to the quality and utilization of clinical services. Serves on various Hospital committees as assigned.… more
- University of Utah Health (Salt Lake City, UT)
- …and supporting coordination of care activities under the direction of a registered nurse and/or social worker. The incumbent interacts with representatives ... discharge plans prepared and delegated by social work or nurse case management by coordinating with home care agencies,...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- BronxCare Health System (Bronx, NY)
- …response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal ... the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify patterns and… more
- Highmark Health (Little Rock, AR)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Arnot Health (Elmira, NY)
- …of an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three to ... . The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's...The Case Manager tracks and trends LOS , resource utilization , outliers, readmissions , denials , delay days… more
- Beth Israel Lahey Health (Needham, MA)
- …in Nursing (or equivalent) required. Master's degree in Nursing preferred. License Registered Nurse required., and Certificate 1 Basic Life Support required., ... you're making a difference in people's lives.** Job Summary: The nurse director provides 24-hour operational accountability for his/her unit(s). Collaborates with… more
- Atlantic Health System (Morristown, NJ)
- …A core focus of this role is optimization of post-acute care utilization , length of stay, and outcomes, supporting value-based care, readmission reduction, and ... AHS standards. + Monitor and optimize PAC network performance, including utilization patterns, readmissions from SNF, ED transfers, and avoidable acute escalations.… more
- Mount Sinai Health System (New York, NY)
- …Business, or related field strongly preferred + **Licensure/Certification** : + Active RN license in the state of employment required + Certification in Case ... Management (CCM, ACM) or Utilization Management preferred. + 7+ years of experience in...+ 7+ years of experience in clinical acute clinical, utilization management, appeals management or related operations + 3+… more
- Elevance Health (Portsmouth, OH)
- …Coordinator-Clinician** is responsible for working under the direction/supervision of an RN , with overall responsibility for the member's case. As required by ... the scope of licensure including, for example, assisting the responsible RN with telephonic or face-to-face assessments for the identification, evaluation,… more
- Sea Mar Community Health Centers (Seattle, WA)
- …+ Respect the culturally diverse backgrounds of Sea Mar patients and staff. + The RN /LPN will work closely with the Nurse Manager and Nursing Supervisors in ... Mar is a mandatory COVID-19 and flu vaccine organization Nurse Floor Supervisor - Posting #27405 Hourly Rate: $38.46...independently as possible. The Facility is looking for an RN or LPN licensed in WA State that has… more