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...
Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery... to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization...) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests...
, and processing referrals for medical services. The nurse will utilize review criteria, policies, and guidelines to ensure appropriate... acute care experience 2 years health plan utilization review or equivalent ICD-9 and CPT coding experience preferred...
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...
, provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data..., Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse (RN);current...
case management program. Acts as a liaison between the patient, family, nurse, physicians, multidisciplinary team.../Certifications: Registered Nurse (RN) licensure in the state of practice: Required Case management certification: Preferred...