- Dignity Health (Rancho Cordova, CA)
- …work from home within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may include: - Manages… more
- HonorHealth (AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Saint Luke's (Kansas City, MO)
- **Job Description** The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization ... using clinical guidelines (InterQual). + Complies with CMS regulation regarding utilization review /management. + Obtains and manages insurance authorizations and… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... leader for system services for wholly owned and Partner hospitals for utilization management. Job Duties OPERATIONS: Plans, organizes and delegates activities as… more
- Prime Healthcare (Ontario, CA)
- …working for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) ... + Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager… more
- Prime Healthcare (Reno, NV)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... institution in a Health and Human Services field is highly preferred. 2. Utilization Review experience is highly preferred. 3. Clinical experience in acute… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more