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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. CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio.
$31.7 - $42.35 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Assists the Manager of Case & Utilization Management and/or the Regional Director of Quality Risk & Utilization Management in preparing required documentation for Health Plan audits and appeals.
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Demonstrated leadership experience in BH utilization and care management, particularly for members with Severe Mental Illness (SMI), Substance Use Disorders (SUD), co-occurring physical health issues, and dual disorders of mental health and substance abuse.
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Member, Eligibility (LOB, Plan), Provider, Claim data, about Risk Calculation, Care Plan Implementation, Grievance and Appeals, Patient Management Utilization Management (Authorization), Drug-Drug Interaction, Medications and Lab data Management, CDPS (Analytics) etc., Azure, EDI.
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Job Title: Licensed Vocational Nurse Utilization Review- Utilization Management. Department: Utilization Management. The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products.
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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 Oklahoma City, Oklahoma.
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Specialized experience is experience assisting in the management of a multi-level commercial office building (or equivalent non-housing high rise building) consisting of building mechanical system (i.e., HVAC, alarm systems, elevators, etc.
$114,818 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Provides utilization management, clinical documentation integrity, discharge planning and post-acute care needs assessment and acts as a liaison for utilization management and clinical documentation improvement.
$22 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience in utilization review, case management and/or managed care. Minimum of 1-2 years of utilization management experience, case management, managed care regulations; or any combination of education and experience, which would provide an equivalent background required.
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Christiana Care Hospital currently recruiting a Registered Nurse (RN) for our Weekend Incentive Program (WIP) with experience in Utilization Management in an Acute Care Hospital Setting.
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The Utilization Management Nurse will work closely with ED providers to review medical necessity and collaborate for discharge planning, as appropriate. The Utilization Management Nurse will be responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan.
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Case Manager (RN) - Utilization Management - Weekend Incentive Program (WIP) Works collaboratively with the Utilization Management team, Denial Manager, Physician Advisor, Physician staff, Nursing staff, Case Management, Finance, Clerical Support staff and payer liaisons.
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Posted job title: Case Manager (Rn) - Utilization Management - Weekend Incentive Program (Wip) Clinical Documentation, Performance Improvement, Case Management or Utilization Management experience desirable.
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Job Summary: The Director of Case Management directs the Case Management and Utilization Management activities in a Kindred hospital. Participates as a management team member in the Utilization Management Committee and serves on other committees as required and requested.
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Assist the Patient Care Manager with managing various software system reports for the effective care coordination and utilization management that promotes positive patient outcomes (for example but not limited to, therapy utilization, client no visit, missing TIF OASIS, agent visit time, missed visit, rescheduled visits, aide visits no care plan reports) Assist Patient Care Manager in payer source authorizations, as needed.
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utilization management ancillary jobs Company: Metroplus Health Plan
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