- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Review NurseJob Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to perform ... UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care,… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case...the UR Medical Director . The UR Medical Director will review the case and may… more
- University of Utah Health (Salt Lake City, UT)
- …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, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- AmeriHealth Caritas (Newark, DE)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...Management Department to facilitate timely discharge planning.. Reports to: Director , Case Management What we offer Fundamental to providing… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment The range displayed in this job posting… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Primary Responsibilities * Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced… 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 ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… 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. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
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