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Job Summary:The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.
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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 Utilization Review Nurse also partners with providers and facilities to assist with discharge planning. About the roleThe Utilization Review Nurse is responsible for reviewing and processing medical services requests for members of Quantum Health’s employer groups in an inpatient setting and transitions in relation.
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San Jose Behavioral Health currently has an opportunity for a Utilization Review Specialist Per Diem, at our new 133 bed Acute Psychiatric Hospital, located in South San Jose, CA. The Utilization Review Specialist coordinates and assesses the inpatient census for appropriate alternate health care service needs.
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Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise.
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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. BSN Degree from an accredited nursing program or proven success as Registered Nurse Utilization Review I role.
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Qualifications Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care. Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management.
$36.42 - $60.33Full-timeExpandApply NowActive JobUpdated 30 days ago - UpvoteDownvoteShare Job
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Hoboken, New Jersey. Posted job title: Rn Utilization Review, Clinical. Specialty: Utilization Review.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. 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.
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The Registered Nurse Assessment Coordinator (RNAC) is responsible to coordinate fulfillment of regulations relative to the MDS and associated forms, coordinate the interdisciplinary Plan of Care, to ensure appropriate utilization of services relative to levels of care, and to assist the Lead RNAC in ensuring that the highest degree of quality care is maintained at all times for each of the residents.
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B) Receives and reviews third-party payer requests for concurrent review and notifications of denied hospital days; routes to appropriate Utilization Management nurse. Takes appropriate and authorized actions or routes to Utilization Management or Case Management nurse.
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Atrium Health Charlotte is seeking a Registered Nurse (RN) Clinical Coordinator, Utilization Review for a nursing job in Charlotte, North Carolina. Posted job title: Rn Coordinator - Utilization Review Atrium Health Clinical Care Management Remote Prn Days.
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Relevant experience includes previous industry, utilization management/utilization review experience and care coordination. This roles supports the Utilization Medical Policy Committee and creates New Technology policies for committee review.
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Psychiatric Nurse practitioners may participate in utilization review activities as needed to ensure patients are able to access necessary careThe Psychiatric Nurse Practitioner will fulfill all duties in compliance with Pioneer Rural Health procedures including 42 CFR, Part 2 (privacy regulations.
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Piper Companies is currently seeking a Remote Utilization Management Nurse for a remote opportunity within a health insurance organization. Responsibilities of the Remote Utilization Management Nurse:Responsible for performing medical reviews to assess, and coordinate quality care for patientsDetermine medical necessity utilizing MCG criteria and medical policy/contractual benefits.
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utilization review nurse continuing jobs Company: Medical Solutions in AZ, Australia
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