- BroadPath Healthcare Solutions (Tucson, AZ)
- …+ Minimum 3 years of experience in Managed Care, Provider Office, or Utilization Review organization required. + Knowledge of Commercial, Medicare, and Medi-Cal ... **Overview** BroadPath is seeking a highly motivated and results-oriented ** Utilization Management (UM) Nurse ** . Our ideal...Management (UM) Nurse ** . Our ideal **UM Nurse ** will ensure timely review of referrals,… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison...Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent… more
- Houston Methodist Hospital (Houston, TX)
- …with HM performance that demonstrates leadership responsibility LICENSES AND CERTIFICATIONS - REQUIRED RN - Registered Nurse - Texas State Licensure -- ... while providing excellent customer/patient service. Plays a leadership role in utilization review committee which includes identification of opportunities for… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- ChristianaCare (Newark, DE)
- RN Case Manager - Day Shift M-F (Hours: 8a-4:30p with call rotation every 7 weeks) No Holidays or Weekends! Newark, DE Christiana Care Hospital in Newark, DE is ... looking for a ( RN ) Case Manager with experience in Discharge Planning in...Worker - Resolves psycho-social barriers and supports discharge needs. Utilization Management - Reviews patient status for appropriateness and… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- University Health (San Antonio, TX)
- …recent, full time hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. ... clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF...of the State of Texas to practice as a registered nurse is required. National certification in… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Stony Brook University (Stony Brook, NY)
- Registered Nurse 1 (T&RC) - Blood Donor Full-Time Day Shift **Position Summary** At Stony Brook Medicine, our Registered Nurses are critical members of the ... while adhering to a medical regimen. **Duties of a Registered Nurse in the Blood Donor Department...Donor and Therapeutic Apheresis as assigned.. + Perform blood utilization quality assurance, donor related work as assigned. +… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... experience in Case Management in an acute setting or utilization review at a medical group or...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
