- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Primary Responsibilities * Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced… more
- Actalent (Sunrise, FL)
- …in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... in collaboration with an interdisciplinary team, the UMN manages complex cases and contributes to internal process development. This...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …members of the interdisciplinary team. Responsibilities Duties include but not limited to: Utilization Review (UR) Registered Nurse (RN) is responsible for ... the most appropriate options and services to meet their complex health care needs. This includes, but is not...Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
- Ascension Health (Wichita, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- AmeriHealth Caritas (LA)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional...ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION … more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Current driver's license required… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… more
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