us forward every day. Job Overview The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization... with coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation...
Anticipated End Date: 2025-01-03 Position Title: Utilization Management Nurse Job Description: The Utilization... Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes...
us forward every day. Job Overview The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization... with coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation...
Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient... either Case Management or Utilization Management. Responsibilities Review patient files and treatment information...
Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review... processes. The Utilization Management RN is an integral part of the multidisciplinary team, and is highly efficient...
Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role...Job Description: Your Role The Facility Compliance Review team reviews post service prepayment facility claims...
about life at Wellmark . Job Description Provide utilization management review and support to members and health care... review issues and alternative treatment setting options. d. Process utilization management requests by utilizing clinical...
on Utilization Management including concurrent reviews and prior authorizations Utilization Management concurrent review and prior... for Utilization Management (Concurrent Review and Prior Authorizations) Qualifications: Your Knowledge and Experience Requires...
Overview: KNAPP MEDICAL CENTER IS LOOKING FOR A PRN REGISTERED NURSE CASE MANAGER TO WORK WEEKENDS... and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the...
to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate... Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality...
position to all audiences Performs other duties as assigned Position: UM Outpatient Clinical Review Nurse /Utilization...Purpose Contributes to the overall success of the Utilization Management department by performing clinical reviews...
application of policies and guidelines to emergent/urgent and continued stay reviews. Job Responsibilities: Perform review... or forward requests to the appropriate Physician or Medical Director for secondary review. Complete medical necessity and level of care...
. What previous job titles or background work will be in this role? Clinical Review Nurse - Prior Authorization, utilization review...Job Description: Job Title: Clinical Review Nurse - Prior Authorization Location: Remote Duration: 3 months...
description and/or job title. Positions in this function require various nurse licensure and certification based on role and grade level... team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases/requests for services require additional...
Overview: Clinical Reimbursement Review Nurse is responsible for data collection and data entry that represents the... residents’ level of care requirements into the utilization software for Maryland Medicaid, in accordance with Federal and State...
Overview Clinical Reimbursement Review Nurse is responsible for data collection and data entry that represents the... residents’ level of care requirements into the utilization software for Maryland Medicaid, in accordance with Federal and State...
delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical... records in health management systems according to utilization management policies and guidelines Works with healthcare...
Position: ASSOCIATE NURSE MGR/ UTILIZATION REVIEW RN Dept: Inpatient Behavioral Health Shift: Full time 72 hours/pp... MANAGER AND 48 HOURS/PP UTILIZATION REVIEW RN. The Associate Nurse Manager (ANM)-Inpatient Unit serves as an extension...
Manager, Clinical Claim Review who is responsible for supervising the day-to-day prepay, post-pay, and utilization review... activities of a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers. Oversees and manages the daily...