- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of… more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided ... EXPERIENCE REQUIREMENT** + Five (5) years of health care experience as a Registered Nurse . **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a … more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to… more
- Saint Luke's (Kansas City, MO)
- **Job Description** The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through ... utilization review and management . This...billing. **Job Requirements** Applicable Experience: Less than 1 year Registered Nurse - Various Associate Degree **Job… more
- Catholic Health Services (Melville, NY)
- …from payors for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as ... care to MCC in response to physician order, or review of updated clinical information + Acts as a...current with industry standards and business objectives related to Utilization and Care Management as appropriate. +… more
- McLaren Health Care (Grand Blanc, MI)
- …Three years of recent case management , clinical documentation, or utilization review experience + Five years of clinical nurse experience in an acute ... 8. Educates health team colleagues about complex clinical appeals, utilization review , including role, responsibilities tools, and...and directed. **Qualifications:** _Required_ + State licensure as a registered nurse ( RN ) + Bachelor's… more
- Sharp HealthCare (La Mesa, CA)
- …3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA Board of Registered Nursing ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe RN … more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506002318 Description : DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart ... for case management scope of services including: Utilization Management supporting medical necessity and denial... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- UPMC (Pittsburgh, PA)
- …and proficiency in all aspects of member care, to include complex and/or specialized care. + Registered Nurse ( RN ) with an active PA License required + BSN ... experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or...(BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) + Act… more
- MVP Health Care (Tarrytown, NY)
- …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join...interdisciplinary teams to ensure optimal patient care and resource utilization . + Document review outcomes and maintain… more