- MVP Health Care (Tarrytown, NY)
- …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have...interdisciplinary teams to ensure optimal patient care and resource utilization . + Document review outcomes and maintain… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- Elevance Health (Norfolk, VA)
- …Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in ... **Psychologist Reviewer ** **Hybrid 1:** This role requires associates to...external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and… more
- Sharp HealthCare (La Mesa, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as… more
- Northwell Health (Staten Island, NY)
- …care according to regulatory standards. * * Performs concurrent utilization management using Interqual criteria. * Conducts chart review for appropriateness ... management and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge planning, preferred. *… more
- St. Luke's Health System (Boise, ID)
- …Luke's is truly a great place to work. The **Director of Clinical Review Management ** provides strategic and operational leadership across multiple settings and ... operating units to lead the organization's utilization management function in support of SLHS...: City** _Boise_ **Category** _Nursing Leadership_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_… more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across all hospitals and central departments. Establishes… more
- PeaceHealth (Vancouver, WA)
- …of stay consistent with external regulations and standards. + Provide utilization management including facilitating appropriate status assignment per Medicare ... management , quality assurance/quality improvement, clinical documentation and/or utilization management using Intensity Severity Discharge (ISD). (Preferred)… more
- Evolent (Carson City, NV)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more