utilization review specialist
utilization review nurse
1-15 of 355,553 Jobs
RN Care Coordination
Arroyo Grande Community Hospital
Arroyo Grande, CA
The Care Coordinator consistently conducts the utilization review process and the discharge planning process as required by hospital policies, standards of practice and Federal and State regulations.
RN - PEP-C/MOC - Westwood
Los Angeles, CA
Experience in the creation of educational teaching material for patient care/staff utilization.
$51.87 - $77.11 an hour
Sigma Systems Inc
Directly supervise COTAs and Rehab Techs in skilled tasks during group and individual treatment in a manner that promotes efficient and effective utilization of resources and facilitates the ongoing development of clinical skills in accordance with State Practice Acts, Omnibus Reconciliation Act (OBRA), and Reliant Rehabilitation policy.
Inpatient RN - Care Coordinator
Documents plan of care and utilization issues in appropriate locations, including but not limited to: case management/utilization review software and the multidisciplinary plan of care document on all assigned patients.
Prior Authorization RN - Custom Team - Telecommute
Tampa Palms, FL
Keywords: Preservice Review, Nurse, RN, Prior Authorization, Preservice, Utilization Review, InterQual, medical necessity review, remote, Telecommute, Telecommuter, acute care, hospital inpatient, med surg, medical surgical, ER, emergency room
Nurse Practitioner Long Term Care
Primary Responsibilities: Provide preventative or primary care in assigned long term care facilities Work with primary care physicians to provide the best care possibleCollaborate with the nursing staff and the patients' familiesWork with the facility's utilization review processLearn more about palliative care This position works a fixed schedule and requires the ability to manage a case load of patients with varying degrees of illness.
+ Supports standards of medical care through adherence to existing policies and procedures for: admission to the infirmary (when available), transfer to emergency room and utilization review process for specialty consultant referrals.
A1A Precertification Utilization Management Nurse Consultant
New Albany, OH
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Prior Authorization Nurse I
Envolve Pharmacy Solutions
Des Moines, IA
For North Carolina only: In addition, these individuals will conduct utilization management activities, including but not limited to prior authorization, concurrent review and retrospective review.
RN Field/Case Manager
AT HOME HEALTH CARE
Responsible for evaluating utilization of patient services and patient progress; review evaluation with the care team, patient, family members, physician, and Clinical Care Coordinator as needed.
Manager, Lease Abstacting
TRC Total Renal Care
Partnering with Real Estate Legal (Openers), Real Estate (Genesis), Operations and Lease Administration to drive data utilization and enhance data reporting capabilities.
Behavioral Health Care Manager I (Utilization Management)
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
Utilization Review Care Manager (LCSW, LPC, LMFT, LCSW, RN)
Current Connecticut state licensure in LCSW, LPC, LADC, LMFT, or RN
Sound Physicians: Clinical Performance Nurse
Sierra Vista, AZ
Additional experience in case management, quality, utilization review, transitional care, or post-acute services preferredExperience with quality improvement initiatives around HCAHPS, CMI, and reducing readmissionCritical thinking skills and proficiency with technology, including electronic medical systems and Microsoft Office
Solution Review Project / Program Manager
San Jose, CA
Sales, Marketing, Legal, Customer Success and Product Management teams ensuring solutions are actioned accordingly Track progress and provide ongoing oversight of relevant initiatives Analyze solution performance in the marketplace (e.g., solution utilization rates, outcomes, etc.)