- UNC Health Care (Kinston, NC)
- …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... Coordinates and leads all clinical denial processes and clinical audit activities. Collaborates with teammates involved in the denial...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review,… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Centralized Utilization Review (UR) position is responsible for leading the daily operations of the Utilization Review ... department to ensure efficient, high-quality, and compliant utilization management practices across the organization. This position ensures timely initial,… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible for strategic, administrative, and operational leadership for the ... Utilization Management (UM) department across the Houston Methodist system....guidelines **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure - Texas Board of… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...teams to execute our strategic plan for AwareUM. + Audit for product accuracy and effectiveness, communicating with product… more
- TEKsystems (Los Angeles, CA)
- …This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong ... understanding of HMO/Medicare claims processes. Key Responsibilities: + Audit denied provider and member claims for accuracy and compliance + Review and process… more
- McLaren Health Care (Mount Pleasant, MI)
- …6. Provides support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process are met, including ... sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within ... the Utilization Management (UM) program to maximize efficiency, ensure compliance...the pre-authorization management team. Develops, updates, and maintains systematic audit tools to measure compliance with UM Standard Operating… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
- Immigration and Customs Enforcement (Washington, DC)
- …clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing ... needed interpretation and/or translations services are available. d. The correctional registered nurse practices ethically per the Code of Ethics for Nurses with… more
- Northern Rivers Family Services (Queensbury, NY)
- …collaborate with county and community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, ... Type Full Time Travel Percentage Up to 25% Category Nurse Description Psychiatric Nurse Practitioner - Assertive Community Treatment New Hire Retention Bonus… more