- Centene Corporation (Salem, OR)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Molina Healthcare (Warren, MI)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- Texas Health Resources (Arlington, TX)
- Registered Nurse (RN) - Case Manager - PRN Work...and continuity of care to prevent readmission. 35% C. Utilization Review : 1. Performs utilization ... Years in an acute care setting, case management or utilization review Req 1 Year of acute...planning experience Pref Licenses and Certifications RN - Registered Nurse Upon Hire Req And BCCMN - Board Certified… more
- Ventura County (Ventura, CA)
- …candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of experience ... and review ; + Performs daily clinical reviews to support utilization and quality management, ensuring compliance with guidelines and standards for patients… more
- Northern Light Health (Bangor, ME)
- …health care delivery to achieve optimal quality and financial outcomes. * Provides ongoing utilization review of primary care patients. Review for over ... Practice Case Management Department * Manages assigned case load, assessing utilization of resources and services; identifying all patient that require additional… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506002318 Description : DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart center, ... to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title : Nurse Practitioner- Cardiothoracic- Mount Sinai Hospital - Full Time - Night** A nurse practitioner (NP) as described in Title ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Bassett Healthcare (Cooperstown, NY)
- …discuss specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Medical Inpatient units is accountable for ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a new nurse… more
- HCA Healthcare (Houston, TX)
- …planning, implementation and overall evaluation of individual patient needs. Care coordination, utilization review and management, as well as discharge planning ... physicians and other members of the team on issues related to utilization review including inappropriate admissions and placements. Payer-based requests… more