- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more
- ChenMed (Norfolk, VA)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more
- Select Medical (Lake Worth, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Molina Healthcare (Las Vegas, NV)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… more
- Pacific Medical Centers (Renton, WA)
- …The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management (UM) functions of US Family ... and processed in a timely manner. It includes timely review of medical necessity and authorization for all admitted...USFHP Medical Director(s) to develop and implement strategic case management and utilization management yearly… more
- Baylor Scott & White Health (Dallas, TX)
- …or related field preferred. Master's degree preferred. 2. 5+ years of experience in case management , social work, utilization review , or related field. 3. 1+ ... , social services, coordination of patient care, patient access, utilization management , and discharge planning. Directs the...of experience in a leadership role preferred. 4. Registered Nurse (RN) or Licensed Master Social Worker (LMSW) or… more
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health ... discharge plans prepared and delegated by social work or nurse case management by coordinating with home...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- Montrose Memorial Hospital (Montrose, CO)
- …the medical care provided. This position combines the unique skill sets of the Utilization Review Nurse and Clinical Documentation Specialist to facilitate ... Montrose, CO, USA | Case Management | Hourly | 36.17-57.87 per hour 36.17...experience preferred; and one (1) to two (2) years Utilization Review experience preferred. What We Offer:… more