- AmeriHealth Caritas (Philadelphia, PA)
- …www.amerihealthcaritas.com. **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer- Shift Care is responsible for ... managing requests for pediatric shift care services including skilled nursing and home health aide...a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care… 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...and legislative requirements. + Focus on effective and appropriate utilization of alternative levels of care and… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary to support and… more
- Beth Israel Lahey Health (Burlington, MA)
- …Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more
- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... to monitor appropriateness of admissions with associated levels of care and continued stay review . + Communication...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Providence (Mission Hills, CA)
- **Description** RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home ... Management **Job Function:** Revenue Cycle **Job Schedule:** Part time **Job Shift :** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT… more
- Trinity Health (Des Moines, IA)
- …(IA), MercyOne Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient ... **Employment Type:** Full time ** Shift :** Day Shift **Description:** At MercyOne, health care ...discharge. + Carries out hospital programs and principles of utilization review in compliance with hospital policies… more
- Beth Israel Lahey Health (Plymouth, MA)
- …to level of care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely response to denials. + ... **Job Type:** Regular **Time Type:** Full time **Work Shift :** Day (United States of America) **FLSA Status:**...a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager -… more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care , and observation status. + Some ... organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA...skills that promote excellence in the patient experience. **Job Shift :** Days **Schedule:** Part Time **Days of the Week:**… more