Job Description: Overview The Utilization Management (UM) RN is responsible to facilitate care along a continuum... through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization...
Utilization Review Registered Nurse- FT Nights, 5-8 hour shifts- Sunday through Thursday ESSENTIAL DUTIES.... Consistent and timely response to emails and other communications relating to utilization review. Prepare and submit appeals...
Description We're seeking an Inpatient Registry Utilization Review Nurse (PRN) who is responsible for conducting... will: Perform utilization review by completing a timely and comprehensive review of all new observation and inpatient admissions...
information, medical necessity standards, and/or and InterQual guidelines. The Utilization Review Nurse utilizes clinical.... Minimum 2 years experience as an RN preferred. Minimum of at least 2 years as care management and/or utilization management...
an Inpatient Registry Utilization Review Nurse (PRN) who is responsible for conducting medical necessity reviews by utilizing..., and discussions with the attending physician and/or physician advisor. This individual will: Perform utilization review by completing...
school of nursing and a current state Registered Nurse license. Minimum 3 years RN Utilization Manager working for a Health... Plan. At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. Current BCLS...
Review Manager RN to join our Utilization Review team. The Utilization Review Manager RN oversees and directs all operations... of the Utilization Review department. Ensures the effective use and monitoring of healthcare resources to support positive...
Utilization Review Nurse – RN or LVN (Remote, $43/hr) Join one of the nation’s leading managed care organizations... license in Ohio or a compact state. Preference for Ohio residents and licenses. Position Summary The Utilization Review...
. Minimum 3 years RN Utilization Manager working for a Health Plan. At least 3 years of experience in utilization review... and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review...
through the continuum while facilitating the functions of utilization review, utilization management, and cost containment... methods for monthly reporting and statistics for presentation to the Utilization Review Committee. Interfaces with patient...
: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission... with RN Case Managers to expedite patient discharge. 5. Maintains current knowledge of hospital utilization review processes...
a thorough medical record review and knowledge of federal and evidence-based guidelines, including CMS Conditions... utilization management to patients, families, and other members of the care team as needed. Maintains current knowledge of health...
Position Title Case Manager (Utilization Review), Registered Nurse (RN) or MSW Job Description Purpose & Scope...
Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities... Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources...
with our patients and teammates. Job Summary The RN-Case Manager is responsible for assessing, planning, coordinating..., decisions, communications, and patient education in the EMR Participates in performance improvement initiatives, utilization...
Job Summary You will review patient cases for medical necessity and establish service suitability. You'll educate the healthcare...'s health plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. Working...
Responsibilities: Utilization Management Utilizes Payer specific screening tools as a resource to assist in the determination.... Documentation Appropriate and complete documentation of clinical review and denial management in the case management...
policy. X Accept Cookies RN Case Manager - Utilization Review (FTD) Job Details Description Position Summary... The Case Manager Utilization Review utilizes the nursing process for age and diagnosis of specific populations to assess...
and compassionate utilization review? What We're Looking For: Strong leadership and advocacy abilities with a track record of team... support and development Minimum 3 years of hospital utilization review experience preferred At least 1 year of supervisory...
Regional office in Temecula, CA is seeking a Per-Diem RN Central Utilization Review Nurse who will be responsible for carrying.... Ensures compliance of utilization review practices as required by payers, external regulatory agencies, and organization...