Nursing experience in Acute Care hospital and/or care management or utilization review experience in any setting. Current WA... and utilization of services for acute care and post-acute skilled patients. The Care Manager will work collaboratively...
required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare teams... BH member data to improve quality and appropriate utilization of services Interacts with BH healthcare providers...
and requirements along with the precertification/concurrent review monitoring requirements for the various utilization management... guidelines for Utilization Review are followed. Evaluates and initiates action on QIP correspondence i.e., pending...
in a managed care organization (i.e. HMO), two (2) years of which must have included experience as a Utilization Review Nurse... Department is seeking to fill one (1) Utilization Review Manager position in Contra Costa Health Plan, located in Martinez...
Description : Utilization Management Specialist Seven Hills Hospital brings a world of compassion, hope... professionals. We are presently looking for a Full Time Utilization Management Specialist who will be responsible for: The...
GENERAL SUMMARY: Under minimal supervision, reviews and screens the appropriateness of services, the utilization... REQUIRED: Registered Nurse required. Minimum 3-5 years of clinical experience required. Bachelor of Science Nursing required OR four (4...
through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization... patient care experience Current unrestricted registered nurse license in the State of Nevada Organizational skills...
Description : Utilization Management Specialist Seven Hills Hospital brings a world of compassion, hope... professionals. We are presently looking for a Full Time Utilization Management Specialist who will be responsible for: The...
level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review... understanding of criteria sets and their limitations including when a second level review is required. Evaluates appropriateness...
Description Summary: The Utilization Management Nurse II is responsible for determining the clinical... appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible...
Description Summary: The Utilization Management Nurse II is responsible for determining the clinical... appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible...
Description Summary: The Utilization Management Nurse II is responsible for determining the clinical... appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible...
of care support. How you make a difference The Utilization Management Registered Nurse works under the guidance of the... Utilization Provider to oversee the coordination of clinical care daily. This role involves conducting utilization management...
Concurrent Review Utilization Management Nurse will report to the FEP Utilization Management Manager. In this role..., and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies...
Job Category: Nursing Job Description: Primary Duties and Responsibilities The Utilization Nurse utilizes... for medical necessity review of incoming referrals, Pre-Service, Retro and Post Claims requests. The UM Nurse will review the...
Utilization Management (UM) Nurse to join our remote team. In this role, you’ll be at the forefront of clinical decision-making.... At least 1 year of Utilization Management experience in concurrent review or prior authorization. Strong decision-making skills...
of experience in Utilization Review. Highly effective communication skills. Ability to identify appropriate status and physician...Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate...
Overview has an excellent opportunity for a Senior Director of Utilization Management to join our team... of 7,000 + employees! The Senior Director of Utilization Management (Sr. UM) will provide leadership and oversight of utilization...
NURSE MANAGER I - UTILIZATION MANAGEMENT (CONTINUUM OF CARE TEAM) OVERSEES CLINICAL REVIEW , TRANSITION OF CARE, POST... clinical areas to ensure appropriate assignment and utilization; monitoring the use and maintenance of equipment, supplies...
Elite Staffing Network is seeking a Utilization Management Registered Nurse (RN) for a full-time position supporting... utilization reviewissues. Use the same generally accepted standards, norms, and criteria to review thequality, completeness...