- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse I Department: Utilization Management...UM reviews. + Track and monitor all denials, appeals , arbitration responses to payers/audits. + Participates in periodic… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
- Magellan Health Services (Albuquerque, NM)
- …- Care MgmtCare Mgmt, PT - Physical Therapist, State Licensure - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Molina Healthcare (Tacoma, WA)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Corewell Health (Dearborn, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER: University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... care areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates a… more
- UnityPoint Health (Cedar Rapids, IA)
- …care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH ... with physicians, third party payers and regulatory agencies. The UM spcialist will also be called upon to provide... spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD… more
- Nuvance Health (Danbury, CT)
- …or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience in an acute care setting * ... for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering...ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide the team with detailed processes… more
- CVS Health (Baton Rouge, LA)
- …The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to ensure the efficient, compliant, and high-quality delivery of ... NCQA, URAC). + Collaborate with internal and external stakeholders-including clinical leadership, operations, IT, and regulatory bodies-to align utilization… more
- Saint Francis Health System (Tulsa, OK)
- …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), ... notification and performing Nonclinical roles .** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review… more