- Virtua Health (Pennsauken, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a resource to… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based upon position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service suitability. You'll educate ... plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify medical records… more
- PeaceHealth (Eugene, OR)
- **Description** PeaceHealth is seeking a RN Admissions Coordinator/ Utilization Review - Psychiatric Unit for a Per Diem/Relief, 0.00 FTE, Variable position. The ... nursing background and previous admission coordination experience + Required: Registered Nurse in state of practice + Preferred: Psychiatric Mental Health Nursing… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more
- Centene Corporation (Phoenix, AZ)
- …Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. ... within utilization management. + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- CHS (Tucson, AZ)
- …HealthTrust Workforce Solutions has partnered with CHS to provide travel nurse opportunities through a nationwide network of caring, compassionate, and inclusive ... your community and care for your neighbors. This community hospital is seeking a highly skilled nurse to join their team for an 8, 10, or 13 week assignment based on… more
- Centene Corporation (Sacramento, CA)
- …in the state of California** **RN highly preferred** **Role is supporting Concurrent Review team working in PST- experience in CCR is highly preferred** **Position ... Purpose:** Directs the utilization management team to ensure the appropriate application of...policies, and standards preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred… more
- Vanderbilt University Medical Center (Tullahoma, TN)
- …status is ordered. The nurse conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review ... difficulty. + Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business… more