UTILIZATION REVIEWER

Under general supervision of the Director of Case Management, the Utilization Review Nurse provides a clinical review of cases using medical necessity criteria to determine the medical appropriateness of inpatient and outpatient services. Provides feedback and assistance to other members of the healthcare team regarding the appropriate use of resources and...

GetMed Staffing is searching for a strong Utilization Review RN to assist our traveler-friendly client. A minimum of 1-2 years of experience is required. Traveling with GetMed Staffing offers the unique opportunity to gain diverse experiences, both personally and professionally. Gain experience that matters.

Job SummaryThe Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and...

Title: RN Utilization Review II Description: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This RN is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related...

***This position is remote with a clear and current CA LVN license.  The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale...

The Utilization Review RN Care Manager (CM) focuses on ensuring accurate and timely utilization review of the hospital medical surgical and maternal child health inpatient population. Utilization Review includes the process of applying accepted utilization standards and or nationally accepted medical necessity criteria to the clinical information available...

Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and implementation of a discharge plan for an assigned group of patients. The Case Manager serves as a resource for other members of the healthcare team and provides education to...

Victor Valley Global Medical CenterVictorville, CACoordinates and reviews all medical records, as assigned to caseloadActively participates in Case Management and Treatment Team meetingsServes as on-going educator to all departmentsResponsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is...

Essential Duties and Responsibilities:Interview patient and family members to obtain information about home environment, family relationships, health history, and patients personality traits.Assist patients and family to understand, accept, and follow medical recommendations.Perform a variety of services such as arranging for discharge, placement of patients...

General job duties. Types of procedures required. Perform discharge planning for patient to the next level of care and criteria review for admit Equipment utilized in the unit/dept. (Is there computerized charting, medication systems, etc.) EPIC Required skills and minimum years of experience. 2-3 years experience Specific licensures and...

Fortus Healthcare Resources is seeking a Travel Utilization Review RN, Care Manager Registered Nurse for an immediate opening in Kealakekua, HI . Registered Nurse, Care Manager, RN, Registered, Nurse, Manager, Healthcare, Staffing

Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with the most efficient utilization of resources....

TGH Crystal River is a 128-bed Joint Commission-accredited acute care hospital which opened in 1978. In keeping with their heritage, the hospital provides quality, compassionate healthcare to residents of Citrus County and surrounding areas. TGH Crystal River care services include a dedicated orthopedic bone and joint center, cardiac catheterization lab and...

Ready to help us transform healthcare? Bring your true colors to blue. The Role The Claims Nurse Reviewer is responsible for reviewing claims, validating coding and medical necessity of the services submitted and pricing the claims according to appropriate guidelines. This position requires strong clinical and medical coding skills to review claims for...

All RTO submitted upfrontFacility Name: ***Unit: ***Shift:Day 5x8-Hour (08:00 - 16:30)Overtime Multiplier: 8 regular hours in a day OR 40 regular hours in 1 week : 1.3%Double Time Multiplier: NoneCharge Nurse: ***On Call: ***Call Back: 1.3%Holiday: 1.3%Observed Holidays: New Year's Day: Falls Within: 12:00 AM day of - 12:00 AM day afterPresidents Day: Falls...

Part of Mass General Brigham, McLean Hospital is a comprehensive psychiatric hospital committed to providing easy access to superior quality mental health services in the Boston area, Massachusetts and beyond. Since 1811, McLean Hospital has been a world leader in the treatment of mental illness and chemical dependency, research into the cause of mental...

**JOB DESCRIPTION****Job Summary**Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to...

**JOB DESCRIPTION****Job Summary**Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients...

* Work closely with the Clinical Team Managers and the Home Care Utilization Navigator in the following: a. Ensure all clinicians on team consistently meet productivity expectations. b. Visit utilization/coordination of patient-centered care. c. Coordination/scheduling of IDTs. 2. Review initial admission information to provide required clinical...

McLean Hospital is a comprehensive psychiatric hospital committed to providing easy access to superior quality, cost-effective mental health services in the Boston area, Massachusetts and beyond. Since 1811, McLean Hospital has been a world leader in the treatment of mental illness and chemical dependency, research into the cause of mental illness and the...