- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …discharge. + Provides after hour safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for ... to meet the healthcare needs of the patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and Case Management. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...staffs. -Case Manager experience as well as Utilization Review experience ( review medical… more
- The Cigna Group (Sacramento, CA)
- …for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of ... Knowledge of managed care preferred. + Works independently, receiving direction from manager or team leader for new or unprecedented situations. + Manages own… more
- Elevance Health (Chicago, IL)
- **Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in person training sessions, ... and ensures essential face-to-face onboarding and skill development. The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network… more
- Elevance Health (Grand Prairie, TX)
- **Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... and ensures essential face-to-face onboarding and skill development. The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network… more
- Elevance Health (San Juan, PR)
- …information technology and business operations services for health plans._ **Nurse Reviewer I** **Location:** This role requires associates to be in-office 1 ... Friday but must be flexible according to business needs. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... the first two years of employment. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Office/Site… more
- Dignity Health (Carmichael, CA)
- …discharge for appropriate status determination. + Ensures compliance with principles of utilization review , hospital policies and external regulatory ... **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite...collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... We Are:** At **Beth Israel Deaconess Hospital -Plymouth** , our patients always come first. We are...and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager… more
- Houston Methodist (The Woodlands, TX)
- …options to assure maximum benefits for patients and reimbursement for the hospital . + Applies approved utilization criteria to monitor appropriateness of ... At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN)...Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures.… more