- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point ... this position is able to cover a multitude of utilization review functions through point of entry,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- YesCare Corp (Brentwood, TN)
- …standards of best practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. + Track, trend and ... that is transforming lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients within assigned contracts and… more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized ... 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
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Avera (Sioux Falls, SD)
- …Clinical Appeals Specialist to ensure tracking and trending of all Utilization Review related denials/appeals are appropriately documented. + Assists with ... Utilizes third party clinical guidelines for level of care reviews (first level review ), and refers cases to the internal or external physician advisor for… more
- CareFirst (Baltimore, MD)
- …Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent ... and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical information,… more
- Montrose Memorial Hospital (Montrose, CO)
- …provided. This position combines the unique skill sets of the Utilization Review Nurse and Clinical Documentation Specialist to facilitate documentation ... The Career: + The purpose of the Clinical Revenue Specialist position is to ensure the integrity and quality...experience preferred; and one (1) to two (2) years Utilization Review experience preferred. What We Offer:… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The BH Utilization Specialist is responsible for coordination of care for CDPHP members across the ... an acute or subacute level of care. The BH Utilization Specialist will conduct telephonic care coordination...required) + In lieu of behavioral health license, Registered Nurse with valid New York State license, with experience… more