- CaroMont Health (Gastonia, NC)
- …preferred. Minimum 2 years nursing experience. + Experience in case management , home health, utilization management , or hospital/community setting ... in MS Office and electronic documentation. + BLS required within 3 months of hire. + Case Management certification preferred for RNs. EOE AA M/F/Vet/Disability more
- ERP International (Yuma, AZ)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management ... databases for community resources, etc. + Integrate CM and utilization management (UM) and integrate nursing...the certifications below **OR** Possess a Master's Degree in Nurse Case Management from a program accredited… more
- Rochester Regional Health (Rochester, NY)
- …New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience + Bachelor's Degree EDUCATION: ... efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other… more
- Highmark Health (Baton Rouge, LA)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing , or Utilization Review, preferred** + **Three years ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal ... and Grievance Nurse is responsible for conducting daily clinical and benefit...accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and… more
- Evolent (Montpelier, VT)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Sutter Health (San Francisco, CA)
- …Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The ... has frequent contact with patients, families, physicians, the interdisciplinary team, nursing management , quality, ancillary services, third party payers and… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …documentation, understanding of performance improvement processes, knowledge of utilization management processes, clinical documentation requirements, current ... members, Medical Care Cost Recovery (MCCR) and Health Information Management (HIM) staff to ensure severity of illness and...requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse… more
- Independent Health (Buffalo, NY)
- …a current and accurate database. + Provide high quality, professional utilization management services: (medical necessity review for Prior Authorization, ... and concurrent review). + Prompt, courteous, and error free in performing utilization management functions. + Maintain quality of reviews and documentation… more