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UTILIZATION MANAGEMENT NURSE

Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members. Review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare...

CompanyNeuehealth
AddressDallas, TX
CategoryInformation Technology
Salary$25.50 - $38.25 an hour
Date Posted 2 months ago See detail

Utilization Management Nurse

Neuehealth

Dallas, TX

$25.50 - $38.25 an hour

Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members. Review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare...

2 months ago seen See more...

Utilization Management Clinician

Pacificsource

Tacoma, WA

Collect and assess member information pertinent to member's history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services. Coordinate necessary resources t...

2 months ago seen See more...

Mental Health Access Utilization Management Program Coordinator

State Of New Mexico

Albuquerque, NM

$59,739 - $95,582 a year

Procurement and management of contracts with Mental Health parity and behavioral Health Access experts;. Oversight of queries and data calls issued to health insurance companies on behavioral benefits Utilization Management. Inves...

2 months ago seen See more...

Denial Review Nurse - Utilization Management - Hybrid

Astrana Health

Monterey Park, CA

$30 - $45 an hour

Responsible for managing all deferrals and or denials by conducting a comprehensive review of clinical documentation, clinical criteria/guideline, policy, and or EOC/benefit policy Apply clinical knowledge when processing all defe...

2 months ago seen See more...

Registered Nurse - Utilization Management **REMOTE**

Amerit Consulting Inc.

California, United States

$50 an hour

Review post service inpatient medical claims using the ClaimLogiQ (CLQ) system. Will need to work between multiple systems. Focus on Facility Medical Reviews (FMR) for length of stay and level of care reviews per MCG guidelines. R...

2 months ago seen See more...

Utilization Management Nurse - RN

Naphcare, Inc.

Wethersfield, CT

Understanding of the principles and concepts of medical quality assurance and utilization review. Develop, implement, and administer the quality assurance and utilization review processes. Monitor and report on the quality of all...

2 months ago seen See more...

Utilization Management RN

Jayestech Llc

Bronx, NY

$63 - $69 an hour

NY RN License. Epic Chart review Joint Commission triennial Survey experience Medical terminology. 401(k). Dental insurance. Health insurance. Referral program. Vision insurance. Day shift. Monday to Friday. High school or equival...

2 months ago seen See more...

Utilization Management Assistant - Utilization Management

Providence

Hesperia, CA

$20.64 - $31.52 an hour

1 year Experience in a hospital, health insurance company or medical office/clinic setting. Coursework/Training: College level classes, preferably in healthcare or related field. Associate's Degree in Healthcare or related field....

2 months ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Albany, NY

$29.10 - $62.31 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 informatio...

2 months ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Trenton, NJ

$30.39 - $65.66 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...

Utilization Management LVN

Welbehealth

Los Angeles, CA

Chart audits of items including but not limited to consult summaries, imaging results, and procedure summaries to determine if additional follow up services are requested. Oversee departmental clinical inboxes, email inboxes, and...

2 months ago seen See more...

Utilization Management Registered Nurse (RN)

Cinqcare

Buffalo, NY

$71,000 - $81,000 a year

Daily, Weekly review of hospital/SNF individual patient medical records determining reason for admission, review of medical history, anticipating length of stay and discharge needs. Review and analyze the patients treatment plan...

2 months ago seen See more...

Utilization Management Coordinator I (Non-Clinical Phones & Faxes) - (Remote)

Carefirst Bluecross Blueshield

Baltimore, MD

$34,056 - $62,436 a year

Call-center (PreCert) intake associate performing provider related administrative support which includes benefit verification, authorization creation and management, provider escalations and case documentation. Reviews authorizati...

2 months ago seen See more...

Case Manager Utilization RN-Per Diem

Kaiser Permanente

Ventura, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

2 weeks ago seen See more...

Case Management Utilization RN PD Day

Kaiser Permanente

Harbor City, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

2 weeks ago seen See more...

Nurse Case Manager/Utilization Review Nurse I

State Of Vermont

Burlington, VT

80% State paid medical premium and a dental plan at no cost for employees and their families. Work/Life balance: 11 paid holidays each year and a generous leave plan. State Paid Family and Medical Leave Insurance (FMLI). Two ways...

3 weeks ago seen See more...

Case Manager Utilization RN, 32/hr Day

Kaiser Permanente

Panorama City, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

3 weeks ago seen See more...

Manager of Utilization Management (Remote U.S.)

Acentra Health

Remote

$73.7K - $93.3K a year

Oversee, coordinate, and monitor all Clinical team activities related to programs assigned. Ensure adequate staffing, contractual service levels, URAC requirements, and regulatory requirements are adhered to by implementing and mo...

3 weeks ago seen See more...

Utilization Review-Case Management (Full-Time)

Aurora San Diego

San Diego, CA

$66,560 - $124,800 a year

Pay Range: $32/hr. to $60/hr. Admissions: Conduct admission reviews. Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews. Payment Appeals: Prepare and submit appeals to third party payers. Recordkeeping: Maintain...

3 weeks ago seen See more...

Solutions Management Director - Utilization Management

Elevance Health

NORFOLK, VA

Provides consultation and advice to business partners regarding benefits of products and analytics. Explains timelines and measures of success for implementing these products. Coordinates with the Physician Liaison regarding clini...

3 weeks ago seen See more...

Case Manager Utilization RN, 24/hr Mid-Shift

Kaiser Permanente

Los Angeles, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

3 weeks ago seen See more...

Manager - Case Management & Utilization Review, Jay Hospital

Baptist Health Care Corporation

Jay, FL

3 years nursing experience in the clinical setting Required. 1 year Case Management or Utilization Review experience Preferred. Excellent verbal and written communication skills required. Understands health care finance relative t...

3 weeks ago seen See more...

Case Manager Utilization RN-Per Diem Day

Kaiser Permanente

Los Angeles, CA

Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...

3 weeks ago seen See more...

Utilization Review Case Manager CMC

Utmb Health

Friendswood, TX

Demonstrates thorough knowledge of Inter Qual Criteria, CMC Specialty Referral Guidelines and Protocols used to determine status for inpatient admission or observation in Community Hospitals and UTMB-TDCJ Hospital. Performs utiliz...

4 weeks ago seen See more...

Materials Management Utilization Analyst

Saint Luke's Health System

Kansas City, MO

Advanced knowledge and experience with Microsoft Excel, particularly with large data sets, pivot tables, vlookups, etc....

4 weeks ago seen See more...

Utilization Case Manager

Community Health Group

Chula Vista, CA

$90K - $114K a year

Monitors in-patient care and facilitates appropriate transition to out-patient or lower levels of care by referencing CHG-approved clinical criteria for utilization management decisions; reviewing members medical record; communica...

4 weeks ago seen See more...

Nurse Manager Utilization Management

Kaiser Permanente

South San Francisco, CA

Manages the operations of 24-hour departments that may be at multiple locations. Ensures Assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal,...

4 weeks ago seen See more...

Utilization Review RN - Utilization Management Dept OCGMC

Kpc Global Medical Centers Inc.

Santa Ana, CA

$50 - $85 an hour

Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings Serves as on-going educator to all departments. Responsible for reviewing patient charts in...

4 weeks ago seen See more...

Utilization Review Nurse - Case Management

Kern Medical

Bakersfield, CA

$41.32 - $65.10 an hour

New Hire Bonus: $6,000.00. New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan. Shift Differential Pay: 10% of base pay for hours worked from 7:00 PM to 7:30 AM, with two (2) ho...

4 weeks ago seen See more...

Nurse Manager Utilization Management - Newark, United States - Kaiser

Kaiser

United States

Manages the operations of 24-hour departments that may be at multiple locations. Ensures Assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal,...

4 weeks ago seen See more...

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What are the top cities open Utilization Manager jobs?

There are open Utilization Manager jobs in several cities including Los Angeles, Yakima, Honolulu, Jackson, Waterloo, Saint Clairsville, Chicago, Somerset, Latrobe, Kapolei, Albuquerque, Washington,

What companies are hiring for Utilization Manager jobs?

The top companies hiring now for Utilization Manager jobs are Acacia, Acacia Network, Clinica Romero, Emory Healthcare, PROMESA R.H.C.F., Southeast Healthcare, Spectrum Healthcare Resources, Spectrum Healthcare Resources - 3.3,

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