Remote Work. This position is eligible to work remotely as approved by management. Position Qualifications. Graduate from an accredited school of Nursing and licensed as a Registered Nurse in the State of Colorado. Two (2) years previous experience in a psychiatric hospital or other psychiatric setting preferred. Experience in utilization review with insurance companies/payers preferred. Background in an inpatient, emergency room, or family pract...
Job Description. Performs utilization management reviews in accordance with federal and state regulations. Maintains compliance with regulatory changes affecting utilization management. Perform UM reviews (prospective/concurrent/retrospective) for inpatient services according to the NCQA, URAC, CMA & DOH standards and client requirements and/or policies. Reviews UM requests for services against established clinical review criteria, referring case...
Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary: $65,062.40 - $107,348.80 • Completes Utilization Management and Quality Screening for assigned patients. Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards. While pe...
Job Summary. At Gritman, we pride ourselves on being the premier healthcare employer on the Palouse. We bring exceptional care that’s close to home for the members of our community, We are seeking a Staff RN to join our Utilization Review/Case Management team. The Utilization Review Nurse (UR) has skills in areas of Utilization Management (UM), medical necessity and patient status determination. This includes examining medical records, treatment ...
Job Summary. At Gritman, we pride ourselves on being the premier healthcare employer on the Palouse. We bring exceptional care that’s close to home for the members of our community, We are seeking a Staff RN to join our Utilization Review/Case Management team. The Utilization Review Nurse (UR) has skills in areas of Utilization Management (UM), medical necessity and patient status determination. This includes examining medical records, treatment ...
The role of the Utilization Review Nurse actively supports the management of a successful compliant utilization review program through planning, process evaluation, data analysis and establishing goals to obtain entitled reimbursement and comply with regulatory and third party payer utilization guidelines. Seeks and implements methods to effectively streamline appropriate information sharing with payers and other customers. This role performs con...
Company Description. Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow. We’ve stayed true to our focus of findi...
Job Description. This position will be remote role for Nurses in Michigan. Should have a valid MI RN License. Should Have utilization management experience. . Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing facility settings previously. The candidate should be well versed in coordination of care activities along with discharge planning which is a plus for this role in ensuring members are transitioned...
Mountain View Hospital is looking for a Case Manager/Utilization Review to join our team. JOB SUMMARY. Performs utilization review activities in accordance with all state and federal mandated regulations in order to evaluate the necessity, appropriateness and efficiency of medical services provided. Maintains compliancy with regulation changes affecting utilization review and case management. Reviews patient’s records assists in evaluating patien...
About Us. HEALING THE BODY AND MIND. . Founded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for bo...
Overview. This position reviews services to patients of all ages to ensure appropriate status of admission, length of stay and utilization of criteria based Severity of Illness/Intensity of Service. Utilizes clinical and nursing knowledge of documentation requirements to improve overall quality and completeness of clinical documentation of patient records. Qualifications. Nurse with current Illinois RN or LPN license. Five years experience in cl...
Overview. Utilization Review Nurse. . Berkshire Hathaway GUARD Insurance Companies, an A Superior rated Insurance company is seeking a Utilization Review Nurse who is interested in joining a company with a unique culture dedicated to technology and customer service. Become part of our dynamic, growing managed care specialist team. . Berkshire Hathaway GUARD. offers a collaborative company culture with outstanding benefits and competitive compensa...
