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UTILIZATION MANAGEMENT REGISTERED NURSE

Work with patients and providers for the patients best interests by helping to ensure appropriate care and maximizing clients medical benefits; Review clinical information provided by the Hospital Utilization Management Departm...

CompanyWexford Health
AddressSylvania, PA
CategoryHuman Resources
Job typeRegular Full Time
Date Posted a month ago See detail

Utilization Management Registered Nurse

Wexford Health

Sylvania, PA

Work with patients and providers for the patients best interests by helping to ensure appropriate care and maximizing clients medical benefits; Review clinical information provided by the Hospital Utilization Management Departm...

a month ago seen See more...

Utilization Management Representative I

Elevance Health

Norfolk, VA

$14.97 - $26.94 an hour

Job Family: CUS > Care Support Type: Full time. Date Posted: Mar 29, 2024 Anticipated End Date: Apr 12, 2024 Reference: JR110000. Managing incoming calls or incoming post services claims work. Determines contract and benefit eligi...

a month ago seen See more...

Utilization Management Clinician - Behavioral Health

Pacificsource Health Plans

Salem, OR

$88K - $111K a year

Collect and assess member information pertinent to members history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services. Coordinate necessary resources t...

a month ago seen See more...

Utilization Management Nurse

Solis Health Plans

Miami, FL

Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services. Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eli...

2 months ago seen See more...

Behavioral Health Utilization Management Coord, PRN

Piedmont Healthcare

Macon, GA

JOB PURPOSE:The purpose of this position is to ensure that admitted patients have the appropriate level of care,patient status, authorization status, plan of care and meet medical necessity for the Behavioral Healthservices. Thi...

2 months ago seen See more...

Utilization Management Representative III

Elevance Health

NORFOLK, VA

Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inp...

2 months ago seen See more...

Utilization Management Representative III

Elevance Health

NORFOLK, VA

Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inp...

2 months ago seen See more...

Utilization Management Representative II

Elevance Health

PALO ALTO, CA

Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...

2 months ago seen See more...

RN Utilization Management Nurse - Remote in OR

Unitedhealth Group

Portland, OR

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Perform all function...

2 months ago seen See more...

RN Supervisor Utilization Management

Commonspirit Health

Rancho Cordova, CA

Under general supervision this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory g...

2 months ago seen See more...

Care Coordinator - Utilization Management

Villagecare Of New York

New York, NY

$25.01 - $28.14 an hour

Respond to inquiries from members and providers regarding health insurance, benefits, eligibility and authorization. Initiate contact with care management team, provider relations department and external providers to meet member's...

2 months ago seen See more...

Utilization Management Representative I

Elevance Health

NORFOLK, VA

Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...

2 months ago seen See more...

Utilization Management Clinical Registered Nurse (RN) - Clinic

Texas Children's Hospital

Bellaire, TX

In addition, discharge planning and provider education are major components of this process.Think you've got what it takes?Responsibilities* Analyze submitted information including clinical assessments, treatment plan, regulatory...

2 months ago seen See more...

Utilization Management Clinical Consultant

Cvs Health

Baton Rouge, LA

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an...

2 months ago seen See more...

Director of Utilization Management (UM) and Performance Improvement (PI) in Psychiatry

Jamaica Hospital Medical Center

Richmond Hill, NY

Up to $135,000 a year

Utilization Management (UM):. Develop and implement UM strategies to ensure appropriate utilization of psychiatric services, including inpatient, outpatient, and emergency psychiatric care. Oversee the utilization review process,...

2 months ago seen See more...

RN Utilization Management - Per Diem

Guthrie

Sayre, PA

Coordinate and facilitate correct identification of patient status.Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all hospitalized patients have the correct admissi...

2 months ago seen See more...

Registered Nurse - Utilization Manager

Erp International

Little Rock Air Force Base, AR

Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. Performs prospective, concurrent, and/or retrospective utilization revi...

2 months ago seen See more...

Utilization Management RN

Fallon Health

Worcester, MA

Obtain clinical, functional, and psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort with other health care professionals, member and/or f...

2 months ago seen See more...

Care Review Processor with Utilization Review/Managed Care Exp. (REMOTE - CA)

Omg Technology

Long Beach, CA

Provide computer entries of authorization requests/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits. Determine provider contracting status and appropriateness. Determine diagnosis and tr...

2 months ago seen See more...

Sr Utilization Management Nurse RN Onsite/Remote- MA

Optum

Boston, MA

$93.3K - $118K a year

Audit entire medical record for accuracy of the coding on the MMQ to support payment to the nursing facility. Answer patient questions regarding care (medication, treatment) and benefits. Discuss Patient Care specifics with peers...

2 months ago seen See more...

Behavioral Health Utilization Management Nurse

United Claim Solutions Llc

Remote

$60.5K - $76.6K a year

Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request. Collaborate with appropriate parties to apply the...

2 months ago seen See more...

Utilization Manager - Remote

Gentiva

Mooresville, NC

$76.8K - $97.3K a year

Experienced in hospice branch leadership and management. Knowledge of hospice rules, regulations, and Conditions of Participation Proven analytic skills, including mining, evaluation, analysis, and visualization Demonstrated exper...

2 months ago seen See more...

Utilization Management Nurse RN

Optum

Bangor, ME

$58,300 - $114,300 a year

Validates authorization for all procedure / bedded patients UM pre-admission. Ensuring acquisition of pre-certification authorization, urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acut...

2 months ago seen See more...

Utilization Management Consultant

Genesis Healthcare System

Zanesville, OH

In addition the position provides case review information to third party payers, assists in the denial and appeals process, and assesses quality, identifying and reporting potential risk management issues. Living the Genesis Missi...

2 months ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Sacramento, CA

$29.50 - $63.75 an hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical informati...

2 months ago seen See more...

LVN- Utilization Management

Ks Management Services, Llc

Pearland, TX

$54,186 - $66,936 a year

Medical, Vision, and Dental. Tuition Reimbursement. Company Matching 401K. Employee Reward and Recognition Program. Paid time off for vacation, sick, and holidays. Employee Assistance Program. Continuing Medical Education allowanc...

2 months ago seen See more...

Utilization Management Nurse

Cottingham & Butler

Dubuque, IA

$61.4K - $77.8K a year

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, but that and prefers working in a professional office setting with daytime office hours and week...

2 months ago seen See more...

Medical Director, Utilization Management - Remote (Missouri)

Optum

Kansas City, MO

$267K - $338K a year

Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impa...

2 months ago seen See more...

Utilization Management Nurse 2

Humana

Boise, ID

The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge an...

2 months ago seen See more...

Utilization Management Representative II

Elevance Health

Manchester, NH

$15.56 - $24.58 an hour

Job Family: Customer Care Type: Full time. Date Posted: Mar 08, 2024 Anticipated End Date: Apr 26, 2024 Reference: JR108675. Responsible for providing technical guidance to UM Reps who handle correspondence. Assist callers with is...

2 months ago seen See more...

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