- Veterans Affairs, Veterans Health Administration (Tuscaloosa, AL)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: Experience in case management , care coordination, and clinic utilization . Physical… more
- HCA Healthcare (Mcallen, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
- HCA Healthcare (Houston, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
- Highmark Health (Pittsburgh, PA)
- …referral screening/ management . **ESSENTIAL RESPONSIBILITIES** + Prior Authorization & Utilization Management : Reviews pharmacy utilization management ... for both pharmacy and medical benefits and prepares such cases for clinical review when required. Within the context of the request, applies plan-specific benefits… more
- Calvary Hospital (Bronx, NY)
- …Flex Spending, Transit Check. + Free On-Site Parking Requirements Participates in the Utilization Review , Discharge Planning, Risk Management , and Quality ... NYS licensure. + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or Discharge… more
- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... appropriate to the age of the patient treated. + Performs admission review on all inpatients. Attends daily patient rounds and shares professional knowledge,… more
- CareFirst (Baltimore, MD)
- …5 years medical-surgical or similar clinical experience OR 5 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records ... Coordination staff utilizing evidence-based guidelines and critical thinking. Additionally, as a Utilization Review RN, you will collaborate with the Concurrent… more
- Austin Industries (Irving, TX)
- …existing equipment platform and refine and develop and implement new Infrastructure based utilization and management program + Participate in the development of ... **Texas area.** The Equipment Service Manager is responsible for maximizing the utilization of Austin Bridge and Road's equipment across the project spectrum.… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
Recent Jobs
-
Clinical Nurse Manager - Cardiac and Vascular Surgery -OR Experience Required (Riverside Methodist Hospital)
- OhioHealth (Columbus, OH)