- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...Criteria and Milliman Care Guidelines (MCG) preferred. + Current RN license from Maryland Board of Nursing. + CCM… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR ... team members in providing all identified utilization review functions for the organization to...the patient/family, physicians, and the interdisciplinary team, the UR RN ensures the care delivery systems at SPH are… more
- Logan Health (Kalispell, MT)
- … RN to lead the way as our Manager of Clinical Documentation Integrity (CDI) & Utilization Review ! This role is ideal for a collaborative RN leader who ... You'll Be Doing: As the Manager of CDI & Utilization Review , you will be responsible for...little extra reassurance. If you're looking to use your RN experience to guide teams, support providers, and strengthen… more
- Martin's Point Health Care (Portland, ME)
- …preferred + 3+ years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting + ... The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas...Required License(s) and/or Certification(s): + Current Licensure as an RN in Maine and other appropriate jurisdictions as necessary… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review -...dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the ... level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as...Conditions of Participation and Tenet policies Operates within the RN scope of practice as defined by state licensing… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah,...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC...**_REQUIRED EDUCATION/EXPERIENCE_** **:** + Current Texas licensure as a Registered Nurse ( RN ).with a minimum ... observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection control, and payers to resolve care coordination issues. Qualifications: * Education: Registered Nurse ( RN ) license required; BSN preferred. *… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance… more