- Molina Healthcare (NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or… more
- Prime Healthcare (Inglewood, CA)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... institution in a Health and Human Services field is highly preferred. 2. Utilization Review /Case Management experience is highly preferred. 3. 1+ year of… more
- Prime Healthcare (Ontario, CA)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... a Health and Human Services field is highly preferred.2. Utilization Review experience is highly preferred.3. Clinical...interpersonal skills to build effective partnering relationships with physicians, nurse staff , coding staff and… more
- Molina Healthcare (Spokane, WA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care… more
- Veterans Affairs, Veterans Health Administration (Clarksburg, WV)
- …national committees. In addition, coordinate and promote service level Quality Improvement and Utilization Review and ensure that the primary focus is the ... GEC and the HBPC program. These operations are carried out with assistance from staff members from other clinical and support services that are supervised by their… more
- Penn Medicine (Plainsboro, NJ)
- …+ Coordinates discharge planning and communicates plan clearly to patient, family and Utilization Review Nurse , Financial Counselor and outpatient treatment ... + Communicate effectively the essential clinical features of each case with utilization reviewers and monitors patient attendance in scheduled program and length of… more
- Nuvance Health (Danbury, CT)
- …for providing strategic leadership and operational oversight for a team of utilization review staff , denials and appeals specialists, non-clinical ... *System Care Coordination Leader* will be responsible for leading a team encompassing utilization review and denials/appeals specialists and will need to foster… more
- Brockton Hospital (Brockton, MA)
- …service delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered … more