- Northern Light Health (Bangor, ME)
- …health care delivery to achieve optimal quality and financial outcomes. * Provides ongoing utilization review of primary care patients. Review for over ... in a fiscally responsible way. * Works to promote cost containment through utilization management . * Collaborate effectively with physicians and managed care… 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
- US Tech Solutions (RI)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more
- Elevance Health (Indianapolis, IN)
- …is granted as required by law. ** Must be an Indiana resident ** The **Medical Management Nurse ** is responsible for review of the most complex or ... Director on particularly peculiar or complex cases as the nurse deems appropriate. + May make recommendations on alternate...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- Ventura County (Ventura, CA)
- …candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of experience ... evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title - Nurse Practitioner-Pediatric Cardiology - Mount Sinai Hospital - Full Time - Day** A nurse practitioner (NP) as described in ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- WellSpan Health (Lebanon, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- Dartmouth Health (Lebanon, NH)
- …Position Objective * The Case Manager will spend time specific to the role of case management and utilization review : * Lead a collaborative process with the ... nursing required; Master's preferred. * Licensed as a Registered Nurse in the State of New Hampshire. * BCLS...clinical outcomes within the desired time frame. * Conducts review for appropriate utilization of services from… more
- Albany Medical Center (Albany, NY)
- …+ Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to… more