/case management in an acute care setting (Required) or Experience as an ED nurse (Preferred) Experience in ED utilization...Description This UM Nurse role is Part-time at 24 hour a week position, Hours are 10p-10a...
PKWY, Daytona Beach, 32117 The role youll contribute: The role of the Utilization Management (UM) Registered Nurse (RN... is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review...
Services and Utilization Management Physician Advisors that review and determines the appropriateness of hospital admissions... that is or was being provided to the patient in collaboration with bed control, case management, coding, and billing. The Utilization Nurse...
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...
identified as having the need for inpatient/outpatient precertification. ESSENTIAL DUTIES & RESPONSIBILITIES Review... precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. Review...
every day. Job Overview The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization... as a Licensed Vocational Nurse. Minimum of 2 years of managed care experience in Utilization Management/prior authorization...
We are recruiting for a motivated RN Registered Nurse, Utilization Coordinator Denver Health Medical Plan - Remote... utilization review activities to determine the efficiency, effectiveness and quality of medical and behavioral health services...
’s Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented... compliance portion of the level of care. Review data specific to utilization management functions and reports as requested...
every day. Job Overview The LVN, Utilization Management Nurse position will provide routine review of authorization... and efficiency with coverage guidelines. The UM Nurse determines the medical appropriateness of inpatient and outpatient services...
years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred... to assure hospitalizations meet payor requirements. Maintains records of review information and outcomes for billing purposes...
effectiveness in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines..., interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians...
-effective delivery of health care services. Essential Functions Review PA requests for home health services, durable medical... Medicare and Medicaid criteria, Interqual guidelines, and PA Department policies and procedures. Review PA requests...
and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation. Maintains... and efficient utilization of clinical resources, ensuring quality, cost effective care. Provides timely clinical reviews to third...
the appropriate level of care using Interqual criteria. Integrates clinical knowledge with billing knowledge to review... experience in the hospital setting Experience with utilization management within the last 3 years required An understanding...
Overview: Directs the Utilization Management department operations and programs across all product lines in VNS Health... and oversees day to day operations of utilization management (UM) for Inpatient, Outpatient, Prior authorization and rehab/skilled...
Post Service Clinical Review nurse will report to the manager of FEP Post Services. In this role you will be reviewing... claims and medical records review of services rendered to FEP members. Post-Service Clinical Nurse reviews for medical...
Our Client, a Health Insurance company, is looking for a Registered Nurse-Review Analys for their Remote location... include acute patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge...
and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates... with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes...
: Registered Nurse-Review Analys Work Location: Detroit, MI,48226 Duration: 2+ Months Job Type: Temporary Assignment Work... patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge...
: Registered Nurse-Review Analys Work Location: Detroit, MI,48226 Duration: 2+ Months Job Type: Temporary Assignment Work... patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge...