- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… 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 ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...Utilization Management experience is preferred. + Knowledge of coding/ claims processing is preferred. + Experience working with Microsoft… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- AdventHealth (Tampa, FL)
- …leader for additional review as determined by department standards. The Utilization Management Nurse is accountable for a designated patient caseload and ... diseases. **The ro** **le you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical… more
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... We are looking for a Utilization Management RN, to join us in leading...TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes,… more
- Ascension Health (Milwaukee, WI)
- …initiatives. + Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... management function within the insurance plan. + Ensure integration of utilization management functions with network strategy and claims processing. +… more
- Emanate Health (Covina, CA)
- …the United States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity 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. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- CareFirst (Baltimore, MD)
- …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety,… more