Utilization Review RN - United States

Join a mission-driven team dedicated to delivering high-quality patient care as Utilization Review Coordinator. · Support Case Management and Utilization Management operations by ensuring patients receive right care at right time. · ...

The Manager of Utilization Review oversees a team of utilization review nurses to optimize patient care and manage resources effectively. Collaborates with the multidisciplinary team for quality timely and cost effective utilization management to achieve optimal outcomes. · Serve ...

General Statement of Duties: The Utilization Review Manager is responsible for coordinating, managing, and documenting medical necessity and authorization processes for behavioral health services reimbursed by commercial payers. This role supports residential treatment, partial h ...

Description · Job Summary · The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued stay revi ...

· Dane Street, a certified "Great Place to Work" company is seeking a Physician to provide utilization review services for the Group Health Department. · This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical approp ...

We are hiring a skilled LTC Utilization Management Reviewer to join our team. · Type of Opportunity: Full time · Job Exempt: Yes · Work Shift: Days (United States of America)NF LOC evaluations and determinations, · Responsible for the review of all required medical documentation ...

The Utilization Management Review Supervisor manages a remote team of up to 12 clinical reviewers who process prior authorization requests for Medicaid members in the Louisiana market. · ...

Utilization Review Surgery Nurse - RN · Pascagoula Hospital | Full-Time | Monday-Friday rotating weekends/Holidays | · 2809 Denny Ave · Pascagoula, Mississippi · United States · Position Overview: · The Case Manager · focuses on clinical quality and resource management resulting ...

The Utilization Management Manager is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, · continued stays, utilization practices and discharge planning according to approved clinically valid criteria. · Assigns ...

Description · Job Summary · The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continue ...

The After Hours Utilization Management Reviewer is scheduled to work non-traditional hours to provide access to medical necessity determinations for urgent or required coverage requests on a 24/7 basis. · Conduct utilization management reviews by assessing medical necessity, appr ...

The Utilization Review Nurse is responsible for the day-to-day coordination of admission criteria as it relates to healthcare needs of the patient and organization. · ...

The Case Manager coordinates with the interdisciplinary team to expedite medically appropriate, · cost-effective patient care.Coordinates patient care conferences as necessary. · Serves as a consultant to staff, physicians, management, and other healthcare professionals, · ...

This position will primarily work as the case manager on the Observation unit. This position will include a weekend and holiday rotation. This position will be cross trained for other areas within the department. · Conducts utilization review/management as outlined in the UR Plan ...

The Utility Project Manager will be responsible for the planning, · coordination, · and execution of utility-related activities for · a large-scale bridge-tunnel construction project. · This role requires close collaboration with utility owners, · design and construction teams, · ...

The Utility Project Manager will be responsible for the planning, coordination, and execution of utility-related activities for the HRBT project. · This role requires close collaboration with utility owners, · design and construction teams, · and regulatory agencies to ensure tim ...

Quality Program Coordination Senior AnalystThe Ohio State University is committed to enhancing the quality of care provided to patients. The Quality Program Coordination Sr. Analyst will provide clinical and service data analyses and services to the Comprehensive Transplant Cente ...

· Current Saint Francis Employees - Please click HERE to login and apply. · Full TimeDaysSchedule: Monday - Friday | 8:00am - 5:00pm · Job Summary: Develops and implements the hospital-wide Performance Improvement Program, Utilization Management Program, Medical Staff Services/C ...

Description · Job Summary · The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and supporting documentation to ensure medical necessity, appropriate level of care, and accurate clinical documentation. Under the direction of the Utilization Review leade ...

Seeking a Medical Director of Utilization Management Full Time: 40 hrs/wk Mon-Fri 8A-5P Serve as the clinical expert on physician practice patterns, over- and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with g ...