- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- BriteLife Recovery (Englewood, NJ)
- …compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals, ... assigned What we need from you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health or… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization...as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level… more
- Dignity Health (Rancho Cordova, CA)
- …- Strong knowledge nursing requirements in a clinical setting. Knowledge of utilization management programs as related to pre-set protocols and criteria. - ... Review (UR) LVN uses clinical judgement in providing utilization management (UM )services. The focus is...may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review. Responsibilities may… more
- CDPHP (Latham, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- Centene Corporation (Jefferson City, MO)
- …will be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CDPHP (Latham, NY)
- …care experience in a hospital setting required. + Minimum one (1) year quality/ utilization management experience in health care setting preferred. + Experience ... required) + In lieu of behavioral health license, Registered Nurse with valid New York State license, with experience...with utilization management software including Facets, Macess and… more
- Ascension Health (Murfreesboro, TN)
- …for post-discharge care. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer date required. + ... (CCMC) preferred. Education: + Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. **Additional Preferences**… more
- Emanate Health (Covina, CA)
- …Requirement :** **Minimum Experience Requirement :** Minimum of three years of utilization management experience. Experience in quality- related job preferred. ... the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying… more
- UNC Health Care (Kinston, NC)
- …and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided ... the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more