- CareOregon (Portland, OR)
- …Manager Direct Reports Registered Nurse - Clinical Quality Assurance, Registered Nurse - Utilization Management II Manager Title Director, Quality ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Quality Assurance Manager , Clinical Systems Requisition # 25017 Exemption Status Exempt Management Level… more
- Prime Healthcare (Ontario, CA)
- …of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a Health Plan. + At least 3 years of experience ... perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and...in utilization review, referrals, authorizations, denials and appeals. + Current… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... and concurrent medical record review for medical necessity and level of care...this position is able to cover a multitude of utilization review functions through point of entry, observation progression… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... ensure appropriate service utilization . Working under the general supervision of the Director...Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of care...the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs &… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… 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 Type: ... 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
- AmeriHealth Caritas (Philadelphia, PA)
- …Clinical Care Reviewer refers the member to a Special Needs/Pediatric Shift Care Case Manager and works collaboratively with that Case Manager to ensure the ... needed or until the member's 21st birthday + The nurse will maintain current knowledge and understanding of the...a clinical setting + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd party… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director… more
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