- Dignity Health (Los Angeles, CA)
- …and community. + Attends LA County DMH meetings and trainings pertaining to utilization review , billing and audit procedures, data entry, and reimbursement. + ... UR meetings with clinical staff. + Conducts internal audit and utilization review activities on cases and informs clinical and administrative staff of… more
- UCHealth (Broomfield, CO)
- …on applicant's relevant experience Summary: Coordinates preadmission, admission, and utilization review . Develops referral relationships with physicians, ... third party payors with information required for approval process. Reports on utilization review activities. Coordinates admissions with shift Charge Nurse;… more
- Mohawk Valley Health System (Utica, NY)
- …scheduling records. + Participates in agency meetings and the quality improvement and utilization review activities of the organization. + Follows all state, ... records. + Participates in agency meetings and the quality improvement and utilization review activities of the organization. + Follows all state, system and… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse, Social Worker and Clinical Care Leader to ... an acute care setting with discharge planning, continuing care, care management, and utilization review . + Five years clinical nursing experience required +… more
- Carle Health (Normal, IL)
- … issues in appropriate locations, including but not limited to: case management/ utilization review software and the multidisciplinary plan of care document ... coordination and completion of services to meet post-hospitalization needs.Conducts case review presentations to educate peers on unique or challenging cases and… more
- BJC HealthCare (St. Louis, MO)
- …Louis Children's Hospital One Children's Place St. Louis, MO 63110 + Supervises the Utilization Review and Navigator teams + Excellent team culture! + This is ... RN experience + At least 2 years of leadership experience + Utilization Review experience + RN Case Coordination experience **Overview** **St. Louis Children's… more
- BayCare Health System (Bradenton, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... + Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization and individual patient care goals. + Knowledge of regulatory… more
- City of Durham (Durham, NC)
- …coverage policies (NC Service Definitions, ie ACT, CST IOP, SACOT, Innovation Wavier), utilization review , and data management. + Knowledge of: + the signs ... policies (NC Service Definitions, ie ACT, CST IOP, SACOT, Innovation Wavier), utilization review , and data management? + No experience + Beginner level +… more
- Trinity Health (Livonia, MI)
- …and applied criteria. Knowledge of federal, state and local regulation affecting utilization review programs and payments. Knowledge of regulatory and ... accrediting agency standards and regulations relative to utilization review . **BENEFITS AVAILABLE TO YOU AS A COLLEAGUE OF TRINITY** + Competitive compensation +… more
- Elevance Health (Las Vegas, NV)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
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