- UNC Health Care (Kinston, NC)
- …of applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 ... the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria to… more
- Prime Healthcare (Philadelphia, PA)
- …the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, ... Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: * Utilization Management supporting medical necessity and denial prevention * Transition ... services provided, b) leads the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance… more
- Houston Methodist (Houston, TX)
- … committee, actively participates in defining operational strategic objectives for the Utilization Management Program and serve as the liaison to other ... management committee. Assist with the evaluation of the hospital's Utilization Management Program, including annual review and revision of the hospital's UR… more
- Northwell Health (Staten Island, NY)
- …another level of care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for ... management and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge planning, preferred. + Keeps… more
- Sharp HealthCare (La Mesa, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Mount Sinai Health System (New York, NY)
- …: + Active RN license in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization Management preferred. + 7+ years of ... experience in clinical acute clinical, utilization management , appeals management or related operations + 3+ years in a leadership or management role +… more
- Ventura County (Ventura, CA)
- …of the following: + Certified in Case Management , CCM. + Experience with Utilization Management and/or Quality Assurance in a Managed Health Care Plan. + ... more efficient, and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review, case … more
- Houston Methodist (Houston, TX)
- …improvements as needed. + Collaborates with HMCPA on care transition and utilization management initiatives. + Provides strategic vision and execution for ... for providing executive leadership and strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across… more
- WellSpan Health (Waynesboro, PA)
- …Required **Work Experience:** + 2 years Recent acute care experience. Required + Utilization management , care management , or clinical nursing specialty. ... **General Summary** Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources… more