- AnMed Health (Anderson, SC)
- …continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance , and related denial ... is responsible for performing the daily operations of the Utilization Management program at AnMed within the...of severity of illness and intensity of services, regulatory compliance with documentation and physician orders. + Reviews all… more
- CVS Health (Baton Rouge, LA)
- …we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts ... internal and external partners. Key Competencies: * Family-centered care and advocacy * Utilization management and regulatory compliance * Communication and… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts ... NICU clinical expertise * Family-centered care and advocacy * Utilization management and regulatory compliance ...detail and data integrity **Required Qualifications** * Active, unrestricted RN license in Louisiana or a compact license. *… more
- UNC Health Care (Kinston, NC)
- …clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 ... management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a Registered Nurse in the state of North Carolina. **Job Details**… more
- Intermountain Health (Las Vegas, NV)
- …services, including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, ... + Continuous Improvement + Scheduling **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of practice… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as ... Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team: This… more
- Community Health Systems (Franklin, TN)
- …evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts ... extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Katmai (Fort Carson, CO)
- …Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM and ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Nursing Admin - 2506002696 Description : DMC Detroit Receiving Hospital , Michigan's first Level I Trauma Center, helped pioneer the ... DMC Rosa Parks Geriatric Center of Excellence. SUMMARY The Registered Nurse ( RN ) is a...prepares patient for discharge, utilizing established clinical pathways. The RN reports directly to senior unit management ,… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) -...Management and Compliance policies, InterQual, Transition Management , Utilization Management , and other ... dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the...for case management scope of services including: Utilization Management supporting medical necessity and denial… more