- Molina Healthcare (Tampa, FL)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... for serving as the primary liaison between administration and medical staff . Assures the ongoing development and implementation of policies and procedures… more
- Molina Healthcare (Fort Worth, TX)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- Beth Israel Lahey Health (Burlington, MA)
- …**Essential Duties & Responsibilities including but not limited to:** 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies ... and within the Lahey Clinic Professional Practice Model, MA Nurse Practice Act and ANA Standards of Practice and...of Ethics, the Case Manager performs duties relative to utilization and discharge planning. The Complex Case Manager acts… more
- CenterWell (Brooklyn Park, MN)
- … review of clinical documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- CenterWell (Silverdale, WA)
- … review of clinical documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- ChenMed (Philadelphia, PA)
- …record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible reduction ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...required + A minimum of one (1) year of utilization review and/or case management, home health,… more
- Fresenius Medical Center (Farmerville, LA)
- …focal merit review process. Obtains feedback and input regarding the staff performance from the Medical Director and Clinical Coordinator/Charge RN or Nurse ... Supervisor and acts on the feedback as appropriate. Collaborates with staff and Clinical Coordinator/Charge RN or Nurse Supervisor and Medical Director to set… more
- Northwell Health (Staten Island, NY)
- …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. * Keeps ... concurrent utilization management using Interqual criteria. * Conducts chart review for appropriateness of admission and continued length of stay. * Contacts… more
- AdventHealth (Mansfield, TX)
- …performance with oversight to assure capital and fiscal accountability. + Partners with Utilization Management for the Utilization Review Committee as well ... career with AdventHealth, named in 2018 by Beckers Hospital Review as one of the 150 Top Places to...involving physicians and multiple hospital departments, to assure appropriate utilization of hospital resources, appropriate level of care for… more
- Stanford Health Care (Palo Alto, CA)
- …least 3 years in a surgical specialty as a Physician Assistant (PA) or Nurse Practitioner (NP), with a preference for at least 1 year in Plastic/Reconstructive ... development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS),...management team. + Conduct regularly scheduled meetings with the staff APPs. + Ensure clinical competency and adherence to… more