- Veterans Affairs, Veterans Health Administration (Muskogee, OK)
- …Needed for Veterans Act of 2016. Responsibilities The Community Care (CC) Coordinator Registered Nurse ( RN ) is responsible for executing a streamlined ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards,...level degree in Nursing may have opportunity to become registered as a nurse with a state… 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
- Molina Healthcare (WA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred… more
- Beth Israel Lahey Health (Cambridge, MA)
- …SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong spreadsheet, ... on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review … 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
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to...personal growth, we encourage you to apply for our RN Case Manager opening. We promptly review … more
- MTC (Graceville, FL)
- …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... difference every day! Are you a dedicated and skilled RN looking for a meaningful opportunity to provide exceptional...HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are… more
- St. Luke's University Health Network (Allentown, PA)
- …hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial experience related ... regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and… more
- US Tech Solutions (RI)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....entry date. + Current License to practice as a Registered Professional Nurse in New York State… more