- Beth Israel Lahey Health (Burlington, MA)
- …The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse...care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ability to communicate… 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 ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical necessity and level of ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- UNC Health Care (Chapel Hill, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care ... experience required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care ...facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing… more
- Commonwealth Care Alliance (Boston, MA)
- …health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge, Skills ... Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral...+ Interface with Primary/Interdisciplinary Care Team including Care Coordinator, Care Manager , and… more
- Holzer Health System (Gallipolis, OH)
- …organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management. Partners with Social Workers to refer ... care or observation. Monitors the plan of care to ensure the efficient utilization of...taken into consideration. . Professional experience with case management, utilization review , or discharge planning highly desirable.… 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
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