- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or Professional Counselor (LPC)… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- TEKsystems (Los Angeles, CA)
- …Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... Participate in special projects related to claim denials and appeals Required Qualifications: + Active LVN or RN license...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management /Medical Director in the appeals process. + ... it pertains to patient admission/safe discharge. + Participates in utilization management initiatives/opportunities for improvement through departmental… more
- State of Colorado (Denver, CO)
- Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health Hospital Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5132944) Apply Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health… more
- Molina Healthcare (Madison, WI)
- …and data analysts to produce tools to report, monitor and improve utilization management . * Actively participates in regulatory, professional and community ... organization (HMO) regulations, managed health care systems, quality improvement, medical utilization management , risk management , risk adjustment, disease … more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …as a Certified Professional Coder required. + Three to five years of case management utilization review, or compliance related work experience in a hospital ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more