- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Geisinger (Danville, PA)
- …rewarding, lasting career with impact. Job Duties The RN Clinical Access Specialist performs initial, concurrent and retrospective medical record review to determine ... suggests alternatives and assists in ensuring documentation integrity. + Enters utilization review data into database for tracking and trending audits, billing… more
- Rochester Regional Health (Rochester, NY)
- …The Utilization Review Specialist actively participates in the utilization management of patients and evaluating hospital admissions with the use ... to reduce denials and increase compliance, while leveraging expertise from the utilization management team.* Actively participates in analysis of utilization… more
- Emory Healthcare/Emory University (Duluth, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The Utilization Review (UR) Specialist is responsible for conducting medical ... the attending physician and/or physician advisor. + The UR Specialist will perform utilization review by completing...and federal and state regulatory agencies. + The UR Specialist will ensure proper use of Case Management… more
- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a...of Nursing + Current state licensure as a Registered Nurse (RN) + Basic Life Support (BLS) Certification through… more
- Penn State Health (Hershey, PA)
- …status, and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - Utilization ... responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management . MINIMUM QUALIFICATIONS: * Bachelors Degree in Nursing… more
- Penn State Health (Hershey, PA)
- …SEIU Healthcare Pennsylvania **Position** Specialist (Part-time) - VARIED SHIFTS - Utilization Management **Location** US:PA: Hershey | Nursing | Part Time ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATION(S):** + Bachelor's Degree in Nursing… more
- Vanderbilt University Medical Center (Lebanon, TN)
- …preeminent programs in patient care, education, and research. **Organization:** Utilization Management 10 **Job Summary:** Facilitates optimal reimbursement ... appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when… more
- Sanford Health (SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more