- Tenet Healthcare (Detroit, MI)
- …Management policy and regulatory requirements · Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics, ... support overall strategic plans of the Case Management and Utilization Review strategy · Lead Group hospital...Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care… more
- Lawrence General Hospital (Lawrence, MA)
- …an acute care setting with discharge planning, continuing care , care management, and utilization review . + Five years clinical nursing experience ... services across the continuum from pre-admission to discharge and continuing care . JOB RESPONSIBILITIES: + Rounds with...plans. + Works in conjunction with Utilization Review Nurse, Social Worker and Clinical Care … more
- Alameda Health System (Oakland, CA)
- …trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care ) by participating in appropriate ... System Utilization Management SUM Utilization Review...of healthcare resources while maintaining high- standards of patient care . This role involves evaluating medical necessity, assessing treatment… more
- AdventHealth (Glendale Heights, IL)
- …patient reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...legitimacy of hospital admission, treatment, and appropriate level of care . The UM RN leverages the algorithmic logic of… more
- Spectrum Billing Solutions (Skokie, IL)
- …clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment ... for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team....will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing… more
- UNC Health Care (Chapel Hill, NC)
- …patient/families with the complex psychosocial, on-going medical discharge planning issues, continuing care needs by initiating appropriate case management ... episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Providence (Anchorage, AK)
- …of hire. + National Certification in area of specialty. + 1 year experience in care management or utilization review in any setting or successful completion ... Medical Surgical or Inpatient setting. + IRR or annual competency testing in Utilization Review . **Preferred Qualifications:** + Bachelor's Degree in Nursing or… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... etc.) to ensure the patient's needs are met and care delivery is coordinated. The UM completes utilization...with the complex psychosocial, on-going medical transition planning issues, continuing care needs by initiatingappropriate care… more
- Beth Israel Lahey Health (Burlington, MA)
- …Care , Physician Advisors Works collaboratively managing the process of Utilization Review throughout the system **As a health care organization, we have a ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- ERP International (Barksdale AFB, LA)
- …professional organizations, and community health care facilities concerning Utilization Management. + Participates in in-services and continuing education ... **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time...review will be required.Reviews previous and present medical care practices as needed for patterns, trends, orincidents of… more