- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring that ... patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all levels of.... + Collaborate with healthcare teams to facilitate effective utilization management . + Employ MCG criteria and… more
- Prime Healthcare (Joliet, IL)
- …Responsible for the coordination of the various activities of the Case Management Department including utilization management , social services and ... Discharge Plan. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and… more
- Ochsner Health (Slidell, LA)
- …operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems. + Responsible for the accurate ... Medical Records, and Information Systems Departments whose support is necessary for the management and success of the Program. + Adapts behavior to the specific… more
- Catholic Health Initiatives (Lexington, KY)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** **Required...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Prime Healthcare (Evanston, IL)
- …+ Responsible for the coordination of the various activities of the Case Management Department including utilization management , social services and ... Plan. #LI-AG5 Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , or Member ... and review timeliness, workflow volumes, referrals generated to care management programs + Provides administrative support to the grievance and appeals process… more
- RiseBoro Homecare Inc. (Brooklyn, NY)
- …cost-control goals. Technology, Training, and Reporting . Oversee implementation and utilization of facilities management technology systems, including Yardi, ... ESSENTIAL DUTIES AND RESPONSIBILITIES The Director of Facilities Management provides strategic leadership and oversight of the operations, maintenance, and capital… more
- CareFirst (Baltimore, MD)
- …experience. **Experience:** 3 years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient ... This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality… more
- University of Southern California (Los Angeles, CA)
- …Degree Nursing + Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + ... populations. The role integrates the functions of complex case management , utilization management , quality ...the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate… more