- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization + Experience ... the case is presented to the Medical Director for medical necessity review . Upon approval of services, responsibilities include timely notification and education to… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Trinity Health (Albany, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
- Insight Global (Camden, NJ)
- …. The Director of Clinical Review will ideally come from a career as a Utilization Review / Management nurse , and have moved up through the ranks ... New Jersey is searching for a Director of Clinical Review to join their team. The Director of Clinical...searching for a director that lives and breathes case management . We are a company committed to creating inclusive… more
- Premier Health (Dayton, OH)
- …experience Prior job title or occupational experience: Case management , utilization review , clinical nurse Prior specific functional responsibilities: ... with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management , utilization of information systems and regulatory… more
- The County of Los Angeles (Los Angeles, CA)
- …may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge is ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...of Los Angeles, a Utilization Review Nurse is an RN that has Case Management … 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 ... this position is able to cover a multitude of utilization review functions through point of entry,...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...Skills + Clinical review + Utilization review + Utilization management + Interqual ... Utilization Management Nurse (UMN) plays a crucial role in reviewing service...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
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