- Northwell Health (Mount Kisco, NY)
- …RN Case Management and Social Work Services team. Develops processes to monitor utilization review inclusive of length of stay (LOS) and resource reduction ... procedures to improve quality of patient care and plans utilization of staff resources and activities aimed...Nursing. *Current license to practice as a Registered Professional Nurse in New York State, required, plus specialized certifications… more
- Dignity Health (Rancho Cordova, CA)
- …efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality ... patient advocacy, clinical social work and best practice in medical necessity determination and concurrent review . This position will supervise the department in an… more
- University of Southern California (Alhambra, CA)
- …+ Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work ... The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of… more
- Sharp HealthCare (San Diego, CA)
- …when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly ... + Data collectionParticipates in data and statistics collection as requested by Utilization Review , Service Line and Quality Improvement Committees. + Denial… more
- 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
- YesCare Corp (Philadelphia, PA)
- …Engage in all quality improvement initiatives, including sentinel event reviews. + ** Utilization Review :** Participate actively in utilization review ... justifications for non-formulary medication requests when necessary. + **Resource Utilization :** Resolve patient care issues using in-house resources before… more
- Albany Medical Center (Albany, NY)
- …Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving ... of the healthcare team. + Articulates clear expectations with staff and members of the patient care team. +...changes in work efficiently and effectively. Support implementation and utilization of clinical nursing research. Promote the use by… more
- UPMC (Pittsburgh, PA)
- Are you an experienced Pediatric nurse with care management experience? We have a unique opportunity that may be a perfect fit for you! UPMC Health Plan is hiring a ... of care. Collaborates and facilitates care with other medical management staff , other departments, providers, community resources and caregivers to provide… more
- UPMC (Murrysville, PA)
- …of care. Collaborates and facilitates care with other medical management staff , other departments, providers, community resources and caregivers to provide ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
- UPMC (Pittsburgh, PA)
- …of care. Collaborates and facilitates care with other medical management staff , other departments, providers, community resources and caregivers to provide ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more