- Banner Health (Phoenix, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... lives, we want to hear from you. As the RN Case Manager in Care Coordination, you will have...pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of… more
- Cedars-Sinai (CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... for providing strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff… more
- Sharp HealthCare (La Mesa, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe RN … more
- Catholic Health (Buffalo, NY)
- …Cycle and interdisciplinary care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation Integrity. The Middle ... - Clinical Supervisor is responsible for training and mentoring Utilization Review , Clinical Documentation Integrity and Clinical...EDUCATION + Bachelor of Science Nursing (BSN) degree + Registered Nurse with a current New York… more
- Tenet Healthcare (Detroit, MI)
- …provisions and provides interpretation of department policies, in accordance with the DMC Utilization Review Plan. Identifies the need for and drafts or defines ... to ensure timely referral, follow up and documentation. Implements and monitors utilization review process in place to communicate appropriate clinical data to… more
- Molina Healthcare (Rio Rancho, NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational...social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …and administering activities related to clinical review , discharge planning, resource utilization , and utilization review . Your primary goal will be ... Jennie Stuart Health is seeking a dedicated Case Management Nurse to join our healthcare team on a PRN...teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations + Ability… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ... ensuring that patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all levels of care. + Utilize strong… more
- Sutter Health (Roseville, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of… more