- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- Stony Brook University (Stony Brook, NY)
- …hospitalized patients who may be at a high risk for readmission. The RN following these patients must have good clinical and communication skills to address ... the case management plans such as clinical needs, barriers, utilization of resources via assessments and/or progress notes. *...analysis * Adheres to all State and Federal requirements, RN license, JACHO, CMS and DOH regulations. * Maintain… more
- UNC Health Care (Rocky Mount, NC)
- …and cost-efficient care of patients through such case management functions as utilization review and discharge planning. May facilitate the execution of ... reviews for private insurance companies, Medicare and Medicaid, in accordance with utilization review guidelines. Tactfully and effectively informs Manager of… more
- Highmark Health (Harrisburg, PA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Cleveland Clinic (Coral Springs, FL)
- …the use of surgical instrumentation and knowledge of surgical procedure. + Assist RN Circulator to ensure proper room utilization through decreased turnover time ... resources, all while following the guidelines set by the Association of Perioperative Registered Nurses (AORN). You will also be cross-trained as a GI Tech, offering… more
- BJC HealthCare (St. Louis, MO)
- …of RN experience + At least 2 years of leadership experience + Utilization Review experience + RN Case Coordination experience **Overview** **St. Louis ... Louis Children's Hospital One Children's Place St. Louis, MO 63110 + Supervises the Utilization Review and Navigator teams + Excellent team culture! + This is… more
- Wellpath (Franklin, TN)
- …or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge ... **About this role** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across multiple sites and… more
- US Tech Solutions (RI)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
- US Tech Solutions (Branchburg, NJ)
- …on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skill ... Schedule - 7:30 am-4:00 pm M-F We need an RN that has at least 5 years' experience in...Tissue/Blood banking * Critical care skill set. The chart review is critical, and the candidate must have knowledge… more
- Evolent (Springfield, IL)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
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