- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based ... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards,...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Trinity Health (Troy, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to...(Outlined in Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education:… more
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... the areas of utilization criteria, appeal and review process, and case management system documentation....staff **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more