- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures ... within the Utilization Management (UM) program to maximize efficiency,...required work experience. **Licenses/Certifications Upon Hire Required:** + Health Services\ RN - Registered Nurse -… 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
- 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
- Community Health Systems (Siloam Springs, AR)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating...coordinating patient care activities under the supervision of a Registered Nurse or physician. This role involves… more
- Community Health Systems (Bentonville, AR)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating...coordinating patient care activities under the supervision of a Registered Nurse or physician. This role involves… 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
- 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
- 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
- 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