. We are in search of a highly motivated candidate to join our talented Team. Job Title: Utilization Review Nurse Location... members. Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization... Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established...
Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient... in either Case Management or Utilization Management. Responsibilities Review patient files and treatment information...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization... Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established...
of experience performing non-clinical functions for prospective Utilization Management review 1+ year of experience providing... for providing non-clinical support to the utilization management team in maintaining and managing the utilization processes for pre...
utilization, cost, efficiency, and appropriateness metrics, as well as clinical outcomes. Tracks outcomes and takes actions... team to review outcomes of the programs, address barriers to success, and develop plans for program modifications...
. To include at least two years’ experience in nursing or one-year related nursing experience in utilization review/insurance/case... years’ experience in utilization review with external payors within a hospital or insurance setting. Highly organized...
. To include at least two years’ experience in nursing or one-year related nursing experience in utilization review/insurance/case... in utilization review with external payors within a hospital or insurance setting. Highly organized with strong communication skills...
for learning. Participates in discharge planning with patients, physicians, social workers, patient education, utilization review...: Registered Nurse (RN) licensure in the state of practice: Required Clinical Nurse Specialist (CNS) in the state of practice...
a patient caseload. Coordinates with other departments, i.e.: Pre-Admissions, Admissions, Patient Accounts, Utilization Review... City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered Nurse (RN) or Licensed Clinical...
with utilization review standards issued by healthcare regulatory agencies. Enter and report patient-level data into ACMS CaseWatch... utilization, including medical co-morbidities, sexual risk behaviors, substance use history, mental health status, housing...
's degree in health-related field, preferred · A Registered Nurse (RN) license or MD diploma (or equivalent) required · Five... or more years of clinical hospital experience; or equivalent of education and experience in case management, utilization management...
specific to Utilization Review and Discharge Planning. The Care Manager partners with the medical staff, utilizes scientific... and providing timely and accurate information to payors. The role integrates and coordinates the functions of utilization management...
assessments, and a variety of medically related tasks. The Supervisor is a registered nurse who works in an administrative role... of the medical practice(s) Assists in the development, review, and revision of standard operating policies and procedures...
and utilization review or social work experience: Preferred One years' leadership experience: Preferred Licenses/Certifications...: Registered Nurse (RN) licensure in the state of practice: Preferred Licensed Master Social Worker (LMSW) - State Board...
utilization. Assures appropriate staff support of Utilization Management and other relevant committees. Supports the... training based on data analysis and review. Responsible for the Policies, Procedures, Budget and Program Documentation...