- LA Care Health Plan (Los Angeles, CA)
- …the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter ... can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management , Medical Directors, and other internal teams to… more
- Fenway Health (Boston, MA)
- Registered Nurse Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ... care to individuals, families, communities, and patient populations. The Registered Nurse 's care delivery is consistent with the Massachusetts Board of Registration… more
- Veterans Affairs, Veterans Health Administration (Georgetown, DE)
- …and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Clinical Nurse Specialist ) II: Exception to Licensure for Graduate ... teamwork, high quality care, patient satisfaction, positive outcomes, appropriate utilization of resources and cost-effective services. The Nurse...of the Nurse II, as a Graduate Nurse Technician Clinical Nurse Specialist … more
- Guthrie (Binghamton, NY)
- …of the clinical manager / director, clinical educator, and/or clinical nurse specialist , department competencies, educational programs, new employee orientation, ... hire. Experience: Two years of recent clinical supervisory experience or charge nurse experience desired Essential Functions: RESOURCE UTILIZATION : + Considers… more
- MyFlorida (Chattahoochee, FL)
- …SHIFTS. This is a highly responsible and professional position serving as a Registered Nurse Specialist within Nursing Services. The ideal candidate will be a ... REGISTERED NURSE SUPERVISOR - 60005446 Date: Jan 8, 2026...Ability to analyze complex reports and determine the service utilization habits of clients and to evaluate the appropriateness… more
- Molina Healthcare (WI)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- ERP International (Hurlburt Field, FL)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... of Disability Management Specialists Commission: Certified Disability Management Specialist (CDMS) Association of Rehabilitation Nurses: Certified… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... of job entry date. Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. *Additional… more
- Northwell Health (Manhasset, NY)
- …team and provide pharmacy recommendations + Education and development of nurse , physician and pharmacy staff development pertaining to transplant and ... and research. + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, and… more
- Cedars-Sinai (CA)
- …reporting to the TPL carrier of all injured worker cases receiving case management services. + Ensures appropriate utilization of medical services within the ... Doing** The Case Manager is responsible for the case management of patient while hospitalized and upon discharge from...of care. Use evidence based review guidelines to conduct utilization review as is appropriate to match the payor… more