- McLaren Health Care (Port Huron, MI)
- …_Preferred:_ * Associate's Degree in a HealthCare related field * Two years of case management or utilization review experience * Three years of recent ... between patients, colleagues and community. 5. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- Katmai (Fort Carson, CO)
- …all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. ... **Job Requirements:** **MINIMUM QUALIFICATIONS** + Associates Degree of Nursing. Registered nurse shall be a graduate from...+ Shall possess a current, active, full and unrestricted Registered Nurses ( RN ) licensed in Colorado or… more
- University of Southern California (Arcadia, CA)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... follows up to resolve problems with payers as needed. + Completes utilization management for assigned patients. + Coordinates/facilitates patient cares… more
- Penn State Health (State College, PA)
- …prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Practice Site Manager RN Registered Nurse - Windmere Centre **Location** ... + Five (5) years of related experience required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN … more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Molina Healthcare (WI)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support... licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review… more
- MTC (Marion, OH)
- …the use of appropriate sanitation methods. 13. Practice basic cost containment and utilization management for patient care and facility operations. 14. Maintain ... + Civic duty and military leave Impact lives with Management & Training Corporation (MTC)! At the **North Central...of all medical records; observe applicable HIPAA rules. 15. Review medical files to determine all provided services are… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the...necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue… more
- MTC (Raymondville, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... Detention Facility in Raymondville, TX** is seeking a dedicated RN to provide compassionate care and support to individuals...of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are… more
- McLaren Health Care (Flint, MI)
- …to meet organizational goals. Assumes responsibility for the clinical administrative aspects of utilization review and case management . Integrates medical ... and procedures as well as documentation of the case management and utilization management processes....in Nursing, health care or business-related field + Valid RN License in state doing business in + Ten… more