- St. Luke's University Health Network (Bethlehem, PA)
- …to agency standards for the provision of quality care, appropriate service utilization , and compliance with third party payor requirements for reimbursement. 7. ... continuing development of staff members. 12. Demonstrates efficient time utilization in the home, in the office, and in...of professional nursing who is licensed as a Registered Nurse by the state in which practicing, Baccalaureate degree… more
- Catholic Health Initiatives (Pendleton, OR)
- …and Responsibilities** **Relocation Assistance Available!** **Job Summary** The Registered Nurse provides leadership and co-ordination to the health care team ... based on ability/competence and scope of practice. + Is aware and demonstrates utilization of proper infection control standards and practices. + Is aware and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Workers' Compensation. The Workers' ... Compensation Nurse Case Reviewer collaborates with medical care providers, employers,...for timely return to work. + Provides case management, utilization review, continued stay reviews, and based on clinical… more
- Moses/Weitzman Health System (Meriden, CT)
- …licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or ... optimal clinical performance and organizational goals for productivity and utilization . **QUALITFICATIONS AND PREFERRED SKILLS** APRN: Graduate of an accredited… more
- Mayo Clinic (Phoenix, AZ)
- …Competitive retirement package to secure your future. **Responsibilities** The Registered Nurse (RN) Case Manager works within an interdisciplinary team to ... of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization , and clinical documentation.… more
- Sutter Health (Roseville, CA)
- …care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
- Nuvance Health (Poughkeepsie, NY)
- …Discharge Planning primarily Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the ... from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned… more
- Geisinger (Danville, PA)
- …services with the goal of optimizing the patient or member's health status. Manages utilization and practice metrics to further refine the delivery of care model to ... coordination of services. + Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency… more
- Molina Healthcare (Salt Lake City, UT)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + ... of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and… more
- Lakeview NeuroRehabilitation Center (Waterford, WI)
- …plan for the patient. + Has overall accountability for care coordination, utilization management, and discharge planning for patients within the assigned caseload, ... for services in any phase of treatment. Participates in Utilization Management meetings to promote sharing of knowledge base,...patients, and families of varied backgrounds. + Education: Registered Nurse , ADN or BSN. + Licensure: Current WI RN… more