. We are in search of a highly motivated candidate to join our talented Team. Job Title: Utilization Review Nurse Location... members. Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines...
Description As the Utilization Management & Quality Review Nurse, you will be responsible for: Ensuring appropriate..., cost-effective, and high-quality care for New Century Health Plan members Conducting utilization management...
Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient... in either Case Management or Utilization Management. Responsibilities Review patient files and treatment information...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization... Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established...
and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management... Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll...
for learning. Participates in discharge planning with patients, physicians, social workers, patient education, utilization review...: Registered Nurse (RN) licensure in the state of practice: Required Clinical Nurse Specialist (CNS) in the state of practice...
utilization, cost, efficiency, and appropriateness metrics, as well as clinical outcomes. Tracks outcomes and takes actions... team to review outcomes of the programs, address barriers to success, and develop plans for program modifications...
with other departments, i.e.: Pre-Admissions, Admissions, Patient Accounts, Utilization Review, PPS Coordinator, etc., to assure positive... City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker...
Description As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health... Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider...
Utilization Review Nurse Remote 2 month contract with probable extension Job Description: Ensuring appropriate..., cost-effective, and high-quality care for New Century Health Plan members Conducting utilization management...
for supervision of Medical Surveillance Programs. Assists in the review of new hires and their medical credentials. Personnel... nursing department. Ensures effective utilization of staff and departmental resources. Monitors overtime requirements...
Programs Assists in the review of new hires and their medical credentials. Personnel Management/Staffing Identifies... effective utilization of staff and departmental resources. Monitors overtime requirements in accordance...
of nursing personnel consistent with those in the Performance Work Statement. Assists in the review of new hires... and position competencies for the nursing department. Ensures effective utilization of staff and departmental resources. Monitors...
Management and the utilization of opportunities within the local healthcare system. The Lead MCM will utilize and maintain... including use of electronic medical records systems and software skills. Knowledge of ICE/DHS medical case review and care...
's degree in health-related field, preferred · A Registered Nurse (RN) license or MD diploma (or equivalent) required · Five... or more years of clinical hospital experience; or equivalent of education and experience in case management, utilization management...
or State regulatory agency requirements specific to Utilization Review and Discharge Planning. The Care Manager partners... of utilization management, care progression and care transition. The Case Manager I is accountable for a designated patient...
. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM... in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The...
, utilization review and management, and discharge planning. Essential Functions Care Coordination Coordinates clinical... and effectively. Utilization Management Conducts medical necessity review for appropriate utilization of services from admission...
's degree in health-related field, preferred · A Registered Nurse (RN) license or MD diploma (or equivalent) required · Five... or more years of clinical hospital experience; or equivalent of education and experience in case management, utilization management...
's degree in health-related field, preferred · A Registered Nurse (RN) license or MD diploma (or equivalent) required · Five... or more years of clinical hospital experience; or equivalent of education and experience in case management, utilization management...