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Job DescriptionJob DescriptionRN- Utilization Review Nurse LTSS/DMEFull Time 100% Remote OpportunityCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE! VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position.
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Lead Tenet Utilization Review Teams market structure and operations management to effectively support utilization review and authorization confirmation functions to promote an appropriate level of care and prevent payer denials.
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Team members typically specialize in either model validation or criteria validation/credit review but will have the opportunity to develop skills and experience across both disciplines. Conduct validation and credit review activities using both qualitative credit skills and statistical / quantitative analyses in the evaluation of ratings performance.
$58,300 - $115,850 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Review Specialist manages daily operations, which include supervising the staff performing benefit enrollments and utilization management activities. The Utilization Review Specialist participates in department development and unit performance improvement.
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The Review Analyst will participate in assigned risk-based activities and is expected to actively contribute to the team's overall validation activities, and so the position will specifically appeal to a diligent and analytically curious self-starter with a strong work ethic and a drive to succeed.
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The Loan Review Manager role provides leadership to our people and clients to deliver Crowe’s loan review and credit consulting services, including outsourced and co-sourced loan review, staff augmentation, credit consulting, and credit remediation.
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Individuals in this role have deep specialization in the loan review and all aspects of commercial banking. 5+ years of experience in loan review, commercial credit management role, professional services or consulting.
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The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
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Must possess strong critical thinking skills, have an ability to perform clinical/chart review and abstract information efficiently. Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
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The Commercial Credit Review Senior Manager is responsible for executing an independent, risk-based assurance review of assigned platforms within Capital One Bank's commercial credit portfolio, including assessment of credit practices, effectiveness of policy implementation and risk rating accuracy.
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When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate.
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Knowledge of relevant sciences applicable to formal energy environmental review, laws, procedures, policies, and social and political pressures. This position exists to fulfill the responsibilities of the Department of Natural Resources (DNR) for energy review interaction, coordination and influencing environmental review conducted by other governmental units, primarily the Department of Commerce/Public Utilities Commission and the Federal Energy Regulatory Commission.
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Prior experience managing within a loan review team and maintaining a network of credit professionals would be a benefit to this role. Loan Review Manager. Have strong sense of responsibility for engagement management, including project planning, oversight, budget tracking, supervision and review of work, oversight and development of staff.
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Strong computer skills with proven ability to use MS Office applications, OASIS review software, and clinical documentation software as well as reports available in these programs. Identifies educational trends for agency and/or per clinician and discusses with Clinical Director and Quality Review Supervisor to further train/educate staff and improve OASIS accuracy.
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Three to Five (5) years experience in Case Management/Utilization Review (as either LCADC, LCPC, LCSW, LMHC, LMFT, RN, Case Manager, or Utilization Review. The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.
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review job Title: clinical licensed social Company: Adventhealth
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