- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established guidelines to determine… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within ... the Utilization Management (UM) program to maximize efficiency, ensure compliance...**Licenses/Certifications Upon Hire Required:** + Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. **Experience:**… more
- Albany Medical Center (Albany, NY)
- …a changing environment. + Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- Dignity Health (Long Beach, CA)
- …teaching and/or mentoring an asset. + Experience in initiation and/or application / utilization of research. + Current California Nurse Practitioner license + ... and/or mentoring an asset. + Experience in initiation and/or application / utilization of research. **Where You'll Work** CommonSpirit Health was formed by the… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of 4 ... *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care… more
- Northwell Health (Sleepy Hollow, NY)
- …patient transfer to inpatient bed and ensures hand off communication to accepting nurse . + Promotes optimum utilization of hospital beds by conducting rounds ... Nursing required. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. *Additional… more
- University of Utah Health (Salt Lake City, UT)
- …of time and attendance of direct reports. + Functions as Case Manager and/or Utilization Review Nurse as necessary. + Tracks and analyzes Case Manager quality ... of service and utilization statistics. + Works collaboratively with information systems personnel...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Trinity Health (Columbus, OH)
- …faxes and authorizations in HealthQuest + Communicate information received from payers to utilization review nurse . + Transmit continued stay reviews and track ... work under the direction of the RN Care Managers, Utilization Review Care Manager and the Social Workers. This...Bachelor's degree preferred. + Medical assistant or Licensed Practical Nurse (LPN) highly preferred. + 5-7 years of customer… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review, case management, ... Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5113983) Apply Senior Medical Management Nurse -… more
- Alameda Health System (San Leandro, CA)
- Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + ... AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. Provides… more