- Morehouse School Of Medicine (Atlanta, GA)
- …from a regionally accredited college or university. Qualifications * Clinical license ( RN , NP, PA, or PharmD) preferred/active. * Proven expertise in trial start-up, ... * Build/manage study budgets; forecast and monitor cost recovery and margin. * Conduct/ review Medicare Coverage Analyses ( MCA ) in collaboration with the CRC… more
- Elevance Health (Atlanta, GA)
- …fraud and over- utilization by performing medical reviews via prepayment claims review and post payment auditing + Correlates review findings with appropriate ... ** Nurse Auditor Senior - Payment Integrity Complex and...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Wellpath (Lemoyne, PA)
- …Care Management Certification. + RN preferred. Experience + Previous utilization review and/or case management and pre-certification experience + Knowledge ... role** The Regional Care Manager (RCM) works collaboratively with the Utilization Medical Director, Regional Medical Directors, and Site Leadership to… more
- HCA Healthcare (Asheville, NC)
- …personal growth, we encourage you to apply for our EHR Support Analyst II - RN opening. We promptly review all applications. Highly qualified candidates will be ... join our team as an EHR Support Analyst II - RN . We care for our community! Just last year,...hands-on training as needed, and to implement division standardization, utilization , integration and optimization plans for clinical applications. An… more
- Centene Corporation (Little Rock, AR)
- …nursing or case management experience. Managed care or utilization review experience preferred. **License/Certification:** LPN, LVN, or RN license. Pay ... local office as needed.** **Licensure Requirements** **Applicants must hold an** **active RN license in the state of Arkansas** **or possess a** **current… more
- Bassett Healthcare (Cooperstown, NY)
- …+ 1 year leadership experience, preferred Licensure/Certifications: + Current NYS Registered Professional Nurse license, required + Current BLS certification, ... discharge planning and others as appropriate to assess quality of care and review outcomes data and develop performance improvement plan when applicable. + Conducts… more
- HCA Healthcare (Salt Lake City, UT)
- …sessions as well as conduct psychotherapy process groups. SW-MSW also perform utilization review functions, including conducting InterQual reviews and obtaining ... in this role: + You will work collaboratively with RN case managers, acute care nurses, physicians, insurance companies,...more years of clinical experience preferred. + Knowledge of Utilization Review , DRG review , and… more
- Dartmouth Health (New London, NH)
- …The manager supervises the work of the nursing staff, to include registered nurses (RNs), paramedics (NRP's), advanced ER techs (AEMT's), health unit coordinators ... ED Manager is knowledgeable in all PerformanceStandards/Expectations of the staff RN . * Communicate standards of care, regulatory requirements and hospital policies… more
- Covenant Health Inc. (Morristown, TN)
- …Excellence, women can have their annual mammograms, biopsies, and can meet with a nurse navigator if needed. The Women's Center offers six newly remodeled labor and ... to achieve desired outcomes. + Collaborates with the Peer Review /PQPR medical staff chair to operationalize assessments of peer...seeks opportunities to reduce waste and redundancy in the utilization of resources. + At a minimum participates in… more
- CareFirst (Washington, DC)
- …experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience ... our Onsite Clinical Navigator team. The Onsite Clinical Navigator ( RN ) embedded at a partnering hospital will conduct concurrent...) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely… more