- The County of Los Angeles (Los Angeles, CA)
- …squatting. Considerable ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management ... Nurse ? In the County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management experience whose primary charge is to ensure… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate...to be a St. Francis Hospital & Heart Center(R) RN . You are at the heart of health. St.… 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, ... efficient, and high-quality outcomes. Identify Veterans requiring disease management and connect them to appropriate internal or external...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Nuvance Health (Poughkeepsie, NY)
- …BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review / Management .Company: Vassar Brothers Medical Center Org Unit: ... case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal ... accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and...URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit… more
- UnityPoint Health (Des Moines, IA)
- …to plan and execute a safe discharge + Collaborate with Utilization Management team on continued stay review . + Collaborates with patients, caregivers, ... continuity through elimination of fragmentation of care/service and facilitates the effective utilization of resources. Serves as educator and a central source of… more
- Hackensack Meridian Health (Neptune City, NJ)
- …screens ED inpatient admissions and observations as specified by the facility's Utilization Management / Review Committee for documentation completeness and ... Medical/Surgical experience. **Licenses and Certifications Required:** + Current state Registered Nurse license. + Certified Clinical Documentation Specialist… more
- HCA Healthcare (Largo, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... of experience in a healthcare environment + Previous experience in accreditation, quality, utilization management , or risk management required. + Knowledge… more
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- CareFirst (Baltimore, MD)
- …addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... 3 years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care experience… more