. Responsibilities: Case Management/Utilization Review Admission Criteria Appeals and Denials Benefits Eligibility Care coordination... Milliman Guidelines Worker’s comp case management Utilization Review Admission Criteria Appeals and Denials Concurrent...
Anticipated End Date: Position Title: Nurse Reviewer I Job Description: Location: This is a Virtual role... benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance...
, neurology, occupational medicine or rehabilitation useful. Strong cost containment background, such as utilization review... useful. Strong cost containment background, such as utilization review or managed care also useful. One to two plus years of recent...
dedicated to promoting customer-focused services for case management, discharge planning, utilization review, and social work...An incredible opportunity is open for a driven Resource Management Nurse Manager with an awarded hospital in the...
. As part of the clinical review process, Temporary/Relief Physician Assistants and Nurse Practitioners can... moment we are in URGENT need of a Nurse Practitioner to take on a Full-Time assignment at the correctional facility located...
on Concurrent Review and Utilization Management Possession of an active, unrestricted, and unencumbered Registered Nurse (RN... Associations to deliver continuous, quality healthcare to our high-risk Members. As the Integrated Transitional Nurse, Rn, you’ll...
management within a managed care environment. Comprehensive knowledge of Utilization Review, levels of care, and observation... and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician...
in our communities. If you have a passion for helping others, we want to hear from you! Our clinics are staffed by board-certified nurse... and eligibility, please visit our Benefits Page ! MINIMUM Master of Science in Nursing as a Family Nurse Practitioner or Bachelor...
in quality assurance and utilization review. 2. Quality Focus a. Maintains high quality by self-monitoring patient care...: QUALIFICATIONS Education: Completion of Accredited Nurse Practitioner program Skill Requirements: Ability to communicate...
policies and procedures for infirmary admissions, emergency room transfers, and the utilization review process for specialty... of care support. How you make a difference The Nurse Practitioner provides a full range of medical services for inmates...
, coverage policies, and evidence-based medical necessity criteria. The PA Nurse also collects and analyzes utilization data... to all populations across the ACA Marketplace, Medicare, and Medicaid. JOB SUMMARY The Utilization Management (UM) Prior...
providers with medication management, refills of medication, MyChart message review in the electronic medical record system... of Nursing (NLN), Commission on Collegiate Nursing Education (CCNE) or equivalent accredited school of nursing. The nurse...
systems, billing and utilization review. Other duties as assigned at the discretion of the Director of Nursing. Participates... in all patient records and in all provider/nurse communications. Fully versed in the functions, services and positions of FHCSD...
Nurse Managers work Monday through Friday! The Department of Public Health (DPH) is recruiting for a Public Health Nurse... and related support staff based on available skills and with consideration for the needs of each patient. Assign, review...
to ensure that Utilization Management (UM) review functions are carried out effectively at the corporate health plan level.... Additionally, this position assists the Senior Appeals & Grievances Nurse with review of written response to requests...
and lymphedema clinics. Summary The Clinical Nurse assumes principal responsibility for the total nursing care, assessment..., planning, implementation, evaluation of each assigned patient. The staff nurse initiates teaching and educates the patient...
Anticipated End Date: Position Title: Nurse Reviewer I Job Description: Location: This is a Virtual role... benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance...
experience. Preferred Qualifications: 3+ years of recent clinical nursing experience Prospective utilization review... Responsibilities: Reviews patient referrals within the specified utilization management policy and regulatory compliance timeframes...
experience. Preferred Qualifications: 3+ years of recent clinical nursing experience Prospective utilization review... Responsibilities: Reviews patient referrals within the specified utilization management policy and regulatory compliance timeframes...
Anticipated End Date: 2025-02-19 Position Title: Wellness Nurse Consultant Job Description: Wellness Nurse... above as that is the territory/market that they will work in. The Wellness Nurse Consultant position is responsible for developing...