- Omaha Children's Hospital (Omaha, NE)
- …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... a wide variety of settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative, flexible, risk taker. **Licenses and… more
- CVS Health (Phoenix, AZ)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and ... Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care … more
- Ochsner Health (New Orleans, LA)
- …experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in state of ... implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management ...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Insight Global (Campbell, CA)
- …reviewing medical documentation and applying health plan guidelines - Experience with Utilization Management (UM) - Knowledge of commercial, Medicare, and ... Job Description - Review approximately 60 medical authorization requests per day...- Apply specific health plan guidelines and policies - Review clinical notes and identify key medical criteria -… more
- Sharp HealthCare (San Diego, CA)
- …by our recruitment and hiring teams. **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. Ensure timely ... be unrestricted. **Essential Functions** + Referral CoordinationEnsures consistent application of the utilization review process for effective utilization of… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Utilization Review Specialist (RN) Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 Hours ... SUMMARY:The Utilization Review Specialist actively participates in the utilization management of patients and evaluating hospital admissions with the use… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or...confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv. Campus Utilization Mgt (10hr shifts) **Galveston, Texas, United States** Nursing & Care Management UTMB Health ... the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria… more
- Trinity Health (Maywood, IL)
- …is Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal… more
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