- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Lawrence General Hospital (Lawrence, MA)
- …appropriate referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care ... As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and...setting with discharge planning, continuing care, care management, and utilization review . + Five years clinical nursing… more
- Actalent (Houston, TX)
- Clinical Review Nurse ( Utilization Management) 100% Remote Job Description The role of the Utilization Management Nurse involves performing ... Perform concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate...setting of care. Essential Skills + 2+ years of utilization management experience + Active Texas RN license +… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …of functions, and the integration of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse (RN) is an active member ... background with 5 years nursing experience. 1-3 years relevant case management or utilization review experience required. Must be able to collaborate effectively… more
- Ascension Health (Destin, FL)
- **Details** + **Department: Utilization Review ** + **Schedule: Part time, 3 days per week; 8 hours per day. 8 am- 4:30 pm** + **Hospital: Ascension Sacred Heart ... Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests… more
- CVS Health (Columbus, OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with personal… more
- Montrose Memorial Hospital (Montrose, CO)
- …the medical care provided. This position combines the unique skill sets of the Utilization Review Nurse and Clinical Documentation Specialist to facilitate ... Cycle Initiatives. All About You : + Current Registered Nurse licensure in the state of Colorado. + Knowledge...experience preferred; and one (1) to two (2) years Utilization Review experience preferred. What We Offer:… more
- ICW Group (Lisle, IL)
- …AND SKILLS** Understanding of Workers' Compensation, Workers' Compensation Managed Care processes, Utilization Review , Telephonic Nurse Case Management, and ... in tracking, resolution gathering, and trending of cost management issues related to bill review , case management and utilization review . + Works closely… more
- Ochsner Health (New Orleans, LA)
- …hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in ... implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management OMC Jefferson...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more