- Molina Healthcare (San Francisco, CA)
- …and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and ... and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management … more
- Elevance Health (Waukesha, WI)
- …** is responsible for overseeing workflow and performance of lower level Utilization Management Managers. Ensures compliance with departmental policies ... **Manager II Utilization Management ** **Hybrid 2:** This role...of goals. + Performs audits to monitor efficiency and compliance with policies. + Hires, trains, coaches, counsels, and… more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay… more
- Community Health Systems (Franklin, TN)
- …evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts ... extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management ... II + Six (6) months of experience in Utilization Management Per Diem RN III ... VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem Registered Nurse II/III - Utilization Management VCMC… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and… more
- Ventura County (Ventura, CA)
- Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply Senior ... Registered Nurse - Hospital Management Utilization ...use; + Recommends alternative levels of care & ensures compliance with federal, state & local requirements; + Assesses… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs + And more **Description** We're seeking an **Inpatient Registry Utilization Review Nurse (PRN)** who is responsible for conducting medical ... patient and hospital financial risk. + Initiate and facilitate RN to RN discussion and/or Physician to...organizational policies and procedures as it pertains to the utilization review process. + Ensure compliance with… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Utilization Management ** for a temporary contract position in support ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) -...Management and Compliance policies, InterQual, Transition Management , Utilization Management , and other ... dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the...for case management scope of services including: Utilization Management supporting medical necessity and denial… more
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