- UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Three to Five years experience in case management or utilization review or proven success as Registered Nurse Utilization Review I role. 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.
$31.7 - $42.35 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
Part-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. Specialty: Utilization Review. Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The Utilization Review Specialist manages daily operations, which include supervising the staff performing benefit enrollments and utilization management activities. The Utilization Review Specialist review functions as the internal resource on issues related to the appropriate utilization of resources & services, coordination of care across agency and utilization review and management.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical guidelines/ criteria to guide medical necessity reviews and will use effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to identify gaps in billing and coding between claims and authorizations, ensure members receive appropriate levels of care, while promoting cost effective medical outcomes.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Maintain departmental databases and compile statistics from utilization management tracking studies•Ensure adherence to Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Utilization Review Accreditation Commission (URAC), Case Management Society of America (CMSA) and other regulatory requirements.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, utilization review, peer review, credentialing and risk management.
$118.44 - $165.82 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Utilization Review in Medicare NOMNC/ABN Letters, Medicare Certifications, hospital referral review, evaluation of hospital records for ICD10 coding, setting of ARD dates, etc., of admissions and readmissions, OBRA scheduling, Part B Authorization as needed, CMI Picture Date.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
$33.3 - $44.49 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Knowledge of managed care principles and practices with an emphasis in Grievance and Appeals and/or Utilization Management. Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Utilization Review Nurse Full Time Days at Trinity Health in Nampa, Idaho, United States Job Description Employment Type: Full time Shift: Day Shift Description: At Saint Alphonsus Health System, we are looking for people who are living out their calling.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Case Management process facilitates communication and care coordination along a continuum through effective transitional care management and utilization management. 2 years of experience in Case Management (Care Coordination or Utilization Management) or successful completion of the Transitions in Practice (TIP) program for Care Manager.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN. MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Edgewood, Kentucky.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs concurrent reviews/retrospective reviews according to guidelines.
$40.28 - $66.78 an hourFull-timeExpandApply NowActive JobUpdated Today
review utilization management jobs Title: orthopaedic Company: Kaiser
FEATURED BLOG POSTS
How to Navigate Hiring Out of State
The job market has shifted significantly in recent years. The accelerated adoption of technology has not only pushed many companies into remote working arrangements but also increased the availability of supporting tools and technologies (i.e., video conferencing and collaboration software).
Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.
Hiring Transparency
Transparency in hiring refers to the open and honest communication and information sharing that takes place between employers and job candidates. It encompasses all aspects of the hiring process, from posting job descriptions to providing feedback on performance during and after the interview process. In today's job market, hiring transparency has become increasingly important for both employers and candidates alike.
Recruitment strategies that are weird, but actually work
In the current candidate-driven job market, recruiters are looking for unique ways to attract talent. Some have resorted to even (dare we say it?) recruitment strategies on the border of weird and wacky. What can we learn from the unusual recruitment tactics that are being used and actually getting results? Here’s a rundown of some unique recruitment strategies that actually work.
How To Make $100K a Year – No BS Strategies & Advice
If you’re like most of us, you’d love to be wealthier. Having more money would alleviate stress. It would make it easier to pay your bills and buy nicer things. Maybe it’d allow you to spend more time with your kids and go on more vacations. You’re not alone if you wish you could somehow earn a more significant income.
How to Write a Recommendation Letter for a Student
When a student applies for their first job or for their next academic degree, they don’t have much experience to showcase their skills and personal qualities. Hiring managers and admissions officers, therefore, often look at recommendation letters as a way to go beyond the student’s GPA and learn more about the student’s skills and personal qualities.
How To Answer “Why Do You Want to Be a Supervisor” in an Interview
Anyone who has worked in a supervisor role knows how challenging yet rewarding it is. But chances are if you're trying to become a supervisor, you'll be forced to answer: