- CareFirst (Baltimore, MD)
- …are subject to change based on evolving business needs. **Licenses/Certifications** : Health Services\ RN - Registered Nurse - State Licensure and/or Compact ... experience. **Experience:** 3 years Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care… more
- University of Utah (Salt Lake City, UT)
- …three years of experience in a patient care capacity OR current licensure to practice as a Registered Nurse ( BSN or APRN ) in the State of Utah and minimum five ... , ACS , CCS -P/H, RHIA , or RHIT ). Preferences Knowledge of utilization review and quality assurance procedures as well as experience with InterQual or Milliman… more
- Carle Health (Champaign, IL)
- …or by the authorization of the Chief Medical Officer and works with our Utilization Management RN team, Clinical Denials Management team and the Physician ... Advisor is responsible for conducting clinical case reviews referred by the Utilization Management Team, the Case Management Team, the Clinical Denial Management… more
- Prime Healthcare (Joliet, IL)
- …of the various activities of the Case Management Department including utilization management, social services and performance improvement. Assists with development ... and authorizations. Maintains and coordinates Medi-Cal (TARS) for presentation to on-site reviewer and files them accordingly or as per facility's procedure. Assists… more
- Prime Healthcare (Evanston, IL)
- …of the various activities of the Case Management Department including utilization management, social services and performance improvement. + Assists with development ... authorizations. + Maintains and coordinates Medi-Cal (TARS) for presentation to on-site reviewer and files them accordingly or as per facility's procedure. + Assists… more
- Community Health Systems (Foley, AL)
- …professionalism, collaboration, and leadership in interdisciplinary environments **Licenses and Certifications** + RN - Registered Nurse - State Licensure ... education experience required + Experience in ICU/Critical Care, case management, utilization review , quality, or inpatient coding preferred **Knowledge, Skills… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …communication on medical issues with VP of Nursing, Nurse Administrator, Registered Nurse ( RN ), and Medical Coordinators2. Maintains medical records, ... POSITION SUMMARY Under the Supervision of the VP of Nursing and Nurse Administrators, works collaboratively and assists in the management of medical care… more
- Stanford Health Care (Palo Alto, CA)
- …. + CCDS - Cert Clinical Document Spec . + CCDS-O or CDIP . + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... + ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. +… more
- KBR (Fort Benning, GA)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... Clearance, or the ability to obtain a clearance. + Current RN license; full, active, and unrestricted license as a Registered Nurse in one of any US State,… more
- LA Care Health Plan (Los Angeles, CA)
- …Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse ( RN );current and unrestricted California ... by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health… more