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Responsible for the initial utilization review screen and the ongoing utilization review process through discharge. Join our team as a PRN, variable shift, Case Management, Registered Nurse in Tulsa, OK.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Proactively conduct concurrent review of inpatient utilization according to identified criteria, and properly documenting decision including all appropriate legal and regulatory requirements.
$82,800 - $115,100 a yearExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The review of care is region specific and consists of outpatient healthcare services on pre-certification requests, outpatient procedures, outpatient services, elective inpatient admissions, home health services, genetic testing, orthotics, prosthetics and complex durable medical equipment.
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As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. 1+ years of utilization review experience using evidence-based guidelines.
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Work experience in documentation improvement, case management, utilization review or hospital quality assurance is preferred. Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse; National certification (e.g. CDS, CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Refers cases requiring clinical review to a Nurse reviewer. The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.
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Collaborates with the Utilization Review Specialist RN regarding medical necessity of inpatient admission, appropriate patient class and duration of hospitalization. The Care Coordination Nurse is responsible for ensuring the provision of quality patient care in the appropriate setting through care coordination, case management, utilization management of inpatient admissions, and transitions of care to different levels of care.
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Work collaboratively with the UM Director and Manager Team to develop,implement, and oversee the utilization management process to include;coordination of prior authorization needs for members engaged with caremanagement, as well as the inpatient concurrent review process to ensuremedical appropriateness, care coordination needs, and discharge planningfor PacificSource patients who have been hospitalized.
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Acts as the Utilization Management nurse for the inpatient acute psychiatric unit. Acts as the Utilization Management (UM) nurse for the inpatient acute psychiatric unit.
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Actively involved in the continued management of patient status/LOC. Provides consultative role as utilization management nurse to clinical and non-clinical departments. POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG/CMS Inpatient List) to determine the medical necessity of a requested hospitalization and the appropriate level of care for that patient.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Experience : Ideal candidate will have 2+ years of post-cardiology Physician Assistant/Nurse Practitioner experience in both inpatient and outpatient. Assists the physician as follows, but not limited to Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee activities.
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Director of Case Management Inpatient Case Manager, Acute Care Hospital, Nurse Director, Hospital Case Management, Care Management, Utilization review, care coordination, complex care, care coordinator, social worker, social services, social work, RN, BSN, MSN, BLS, ACLS,CNE, CCM, ACM, LCSW, jobs, careers.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination.
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Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
$49,200 - $70,300 a yearRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Ensures consistent application of the utilization review process for effective utilization of resources. Identify when services that are not medically necessary and/or not covered benefit and refer to Utilization Review Committee.
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utilization review nurse inpatient jobs
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