- US Tech Solutions (Canton, MA)
- …**Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / his role and ... / Outpatient UM team and works under the general direction of the Precertification Team Manager or department Manager . The Clinical Reviewer is expected to… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an...reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + … more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... Consolidated Patient Accounting Centers (CPAC) for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and… more
- University of Utah Health (Salt Lake City, UT)
- …to UR committee any case that surpasses expected LOS, expected cost, or over/under- utilization of resources. + Performs verbal/fax clinical review with payer as ... advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management/ clinical /or combination; 2 of 4 years ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- Dignity Health (Sacramento, CA)
- **Responsibilities** The ** Utilization Review RN** is responsible for the review of medical records for appropriate admission status and continued hospitalization. ... stays and documents the interactions. + Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
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