- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a...to payers/audits. + Participates in periodic denial meetings with Physician Advisors to review the denials that do not… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Management Certification required + Minimum of 3 years of progressive experience in utilization management and appeal/denial management . + Holds a strong ... a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager -...causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee… more
- AdventHealth (Tampa, FL)
- …diseases. **The ro** **le you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical ... standards. When screening criteria does not align with the physician order or a status conflict is indicated, the...for additional review as determined by department standards. The Utilization Management Nurse is accountable for a… more
- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: + Conduct … more
- Commonwealth Care Alliance (Boston, MA)
- …Director will be responsible for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping ... other medical management team members. + Support the development of utilization management policy initiatives. + Support the development and implementation… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated patient… more
- Guidehouse (New York, NY)
- …nursing. + New York Nursing License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and InterQual guidelines + Ability to ... appropriateness for inpatient level of care or observation services based on physician certification + Gathers clinical information to conduct continued stay … more
- US Tech Solutions (Hopewell, NJ)
- … management principles. + Requires working knowledge of operations of utilization , case and/or disease management processes. - Requires knowledge of ... eligibility requirements. + Requires mentoring knowledge on the operations of utilization /case/disease management . **Education:** + Requires an associate or… more
- AdventHealth (Tampa, FL)
- …other diseases. **The role you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical ... standards. When screening criteria does not align with the physician order or a status conflict is indicated, the...for additional review as determined by department standards. The Utilization Management Nurse is accountable for a… more