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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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STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING Strategic Staffing Solutions is currently looking for Utilization Review RNs for a contract opportunity with one of our largest clients located in Detroit, MI Title: Utilization Review RN - multiple openings Location: Detroit, MI Duration: 12 Months Role Type: W2 contract engagement ROLE SUMMARY UM - Utilization Management.
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Utilization Review RN Case Management. As a Utilization Review Nurse/Integrated Care Manager RN with Sentara, you work together intensely with the patients, families, and members of the medical team to provide patients with the resources they need and help prevent them from being readmitted to the hospital.
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The Utilization Review LVN uses clinical judgement in providing utilization management services. - Preferred 5-7 years of experience in combination of utilization management prior authorization or acute/sub-acute care experience.
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Baylor St. Lukes Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Lukes Health.
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The Utilization Management Coordinator is responsible for all utilization management activities for assigned cases from admission through discharge, including peer reviews and appeals, in accordance with the Utilization Review Plan, for patient population ages 5 years through 21 years, with significant behavioral health needs and Autism Spectrum Disorders or other developmental disorders.
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Training Preferred: Quality Improvement, Behavioral Interviewing, Coaching Skills, Disease Management, Bilingual in Spanish, Certification in Case Management, Professional Utilization Review or Managed Care knowledge, Interqual Admission/Continued Stay criteria knowledge.
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The Case Manager (CM) / Utilization Review (UR) nurse staff augmentation full time role will temporarily fill in for Optum care management teams for short term staffing as well as provide consultative support to the front-line care management team, as appropriate.
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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
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Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only.
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Follows all cases throughout the duration of the admission, working with Utilization Review (UR) Department every few days in Ontrac to send concurrent review clinicals. Determines eligibility for admission/treatment in compliance with hospital policy, utilization review criteria, and State and Federal regulations and/or guidelines.
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The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members Job Description Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
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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.
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Learn more about us: JOB LOCATION Duke Triangle Heart Associates - 1821 Hillandale Rd JOB SUMMARY We are seeking a PRN - Nuclear Medicine Technologist to c oordinate and participate in a variety of technical tasks, tests and determinations involving the utilization of radioactive materials and measurement instrumentation.
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Participate in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
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review utilization jobs Title: associate Company: The Loomis Company
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