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Continuing Care Utilization Review Coordinator Rn Jobs

Utilization Review Coordinator: Rn Or Msw
By The Carolina Center for Behavioral Health At , Greer, 29650
Maintain appropriate records of the Utilization Review Department.
Conducts admission reviews and pre-certs.
Conducts concurrent and extended stay reviews.
Prepares and submits appeals to third party payors.
Participates in activities which enhance professional growth and development.
Demonstrates conduct in keeping with CCBH’s ethical standards.
Utilization Review Registered Nurse (Rn), Care Coordination, Full Time, Days
By MarinHealth Medical Center At , Greenbrae $66.03 - $99.04 an hour
Basic knowledge of government and private insurance benefits (e.g. Medi-Cal, Medicare, DRGs, and managed care), including reimbursement requirements is needed.
Experience in applying evidence based criteria related to utilization management.
Experience using case management software
National certification in Case Management preferred
Complies with all reporting requirements for mandated, risk management, and other medical/legal situations consistent with confidentiality policies and department standards.
Must be assertive and creative in problem solving, system planning and management.
Rn Utilization Review Jobs
By Edward-Elmhurst Health At , Naperville, 60540
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Minimum of two years of utilization review and/or clinical experience
Minimum of two years of utilization review experience
Associate’s Degree or higher in Nursing
Current State of Illinois Registered Nurse licensure
Bachelor’s Degree in Nursing or health care related field
Care Review Clinician, Inpatient Review (Rn) - Mississippi
By Molina Healthcare At , Starkville, Ms $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Benefit Review Rn Jobs
By Imagine360 At United States
Superior time management and multi-tasking skills
Staffs medically complex cases with the Supervisor of Case Management, designee, or Medical Director as directed.
Provides requested diagnosis/prognosis reports and stop loss reports that are received via Medical Management department requests.
Reviews high dollar pharmacy reports to identify appropriate referrals to Case Management or other Medical Management Services.
Assess and review current treatment history to identify appropriate referrals to Case Management Program or other Medical Management Services.
Consistently follows department Benefit Review policies and procedures to complete the review processes.
Utilization Review Rn Jobs
By Saint Luke's Health System At Kansas City, MO, United States

The best place to get care. The best place to give care

Utilization Review, Rn Jobs
By Med Center Health At Bowling Green, KY, United States
Case Management, Utilization Review and/or Coding experience preferred.
Three years of recent clinical Registered Nurse experience in a hospital setting required.
Graduate of a school of nursing required.
Bachelor’s degree in nursing or related field preferred.
Initiates interdisciplinary referrals when appropriate and ensures interdisciplinary referrals have occurred.
Educates internal customers on medical necessity documentation opportunities and reimbursement issues, as well as performance improvement methodologies.
Rn - Utilization Review (Evenings)
By Adelphi Medical Staffing, LLC At Lewes, DE, United States
Previous experience in Case Management including knowledge of Interqual criteria and Utilization Management. Preferred.
Knowledge And Experience With Electronic Health Records
Three to five years clinical experience.
Possess strong communication, problem solving and organizational skills.
Clear Communication Skills Both Written And Verbal
Has Skills To Provides Customer Service To Patients, Team Members And Visitors
Health Care Utilization Review Coordinator (Hurc Ii) - Continuum Of Care
By University of Illinois At , Chicago, 60607, Il
Five years (60 months) of RN experience.
Current AHA BLS/CPR and other required unit specific certifications
Effective communication skills (oral and written) that facilitate therapeutic relationships between patients, family, and health care providers
Intermediate computer skills with the ability to become proficient in the Electronic Health Record (EHR) with on-the-job training
Excellent attendance, interpersonal skills and work history required.
Facilitates coordination of patient services in assigned patient care unit, or department
Utilization Review Coordinator (Rn), Behavioral Health-Per Diem
By Coast Plaza Hospital At , Norwalk, 90650, Ca
Possesses skill set to provide clerical support to the Case Management Department.
Excellent time management skills with a proven ability to meet deadlines.
Demonstrates knowledge and skill set to process BHU Medical TARS
Regularly attends required in-services and continuously takes an active interest in furthering one's knowledge.
Has the willingness and ability to perform all other duties and responsibilities as assigned
Five years + experience in acute care hospital Utilization Review and RN Required
Rn Utilization Coordinator, Denver Health Medical Plan
By Denver Health At , Denver, 80204, Co $76,900 - $115,400 a year
1-3 years clinical experience in a hospital, acute care, home health/hospice, direct care or case management required.
1-3 years experience in care coordination or case management required.
Knowledge and understanding of case management/coordination of care principles, programs, and processes in either a hospital or outpatient healthcare environment.
Prefer experience in health plan case management, care coordination, or member navigation.
Home care/field based case management experience.
Support and collaborate with the UM and CM Managers and Supervisors in the implementation and management of UM/CM activities
Rn Utilization Review - Patient Access
By Penn State Health At , Enola, 17025, Pa
Communicates with the Medical Staff and Nursing Staff any utilization issues concerning patient care activities.
Presents Hospital Issued Notices of Non-coverage to patient/family and attending physician when patient's stay will no longer be covered by Medicare.
Acts as liaison between Hospital, physicians, patients and Medicare/Medicaid/Insurance review staff.
Performs preadmission and continued stay preauthorization for patients identified by Admissions as required this service.
Adheres to Federal and State rules as outlined.
Prepares monthly reports for review by the Medical Staff.
Administrator, Continuing Care Jobs
By Erickson Senior Living At , Warminster, 18974, Pa From $130,000 a year
Financial Management skills; business acumen; familiarity with business practice and principles
Education assistance, certification reimbursement, and student loan refinancing partnership programs are available.
Competitive benefits packages including medical, dental, vision, and PTO
Commensurate with experience starting at $130000.00 / year
A "career for life" approach to professional and personal development for our greatest asset; our employees.
A team of 15,000 employees in 20 communities, partnering and delivering quality care and an exceptional lifestyle to our 25,000+ residents.
Clinical Care Reviewer Ii-Rn - Post Acute Care With Utilization Review Management
By CareSource At , Remote $58,000 - $92,800 a year
Medical management experience is preferred
Time management and prioritization skills
Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
Identify and refer appropriate members for Care Management
Provide guidance to non-clinical medical management staff
Provide guidance to and assist with oversight of LPN and LISW medical management staff
Care Manager Msw - Utilization Review - Olympia
By Providence Swedish At , Olympia, 98506, Wa
Care Manager MSW - Providence St Peter Hospital
SCHEDULE: (1 FTE) MON-FRI 8-4:30 but flexible (weekend and holiday requirements)
$5,000 hiring bonus for eligible external hires that meet required qualifications and conditions for payment.
Check out our benefits page for more information about our Benefits and Rewards.
Master's Degree in Social Work or Related Field.
Care Management Coordinator – Utilization Review (40 Hours/Week, Days)
By EvergreenHealth At , Kirkland, 98034, Wa $20.57 - $32.92 an hour
One (1) year of progressively responsible experience in office or general administrative work
Current Healthcare Provider BLS certification by date of hire
Possesses excellent organizational skills and attention to detail
One (1) year experience in a medical setting
Knowledge of community resources and referral process
Pay in lieu of benefits premium program
Continuing Care Utilization Review Coordinator Rn (Out Patient Experience Only)
By Kaiser Permanente At , Santa Clara, Ca $71.25 - $92.17 an hour
Longitudinal Medi-Cal Case management working closely with RN's and Social work team.
Must be able to work in a Labor/Management Partnership environment.
Minimum one (1) year of utilization experience required.
Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
Demonstrated knowledge of diagnostic codes.
Care Review Clinician, Inpatient Review (Rn)
By Molina Healthcare At , Long Beach, 90802, Ca $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Utilization Review Rn - Providence Everett
By Providence Swedish At , Everett, 98201, Wa
Experience as an RN in an acute care setting within the last 5 years, OR recent Utilization Management experience.
Utilization review or case management experience.
Care Management, medical insurance or discharge planning experience.
Experience with InterQual or Milliman Criteria.
1 year - Experience with Neonatal Intensive Care (NICU) clientele.
Check out our benefits page for more information about our Benefits and Rewards.
Rn Utilization Review Prn
By Intermountain Healthcare At , Denver, Co $34.14 - $60.66 an hour
Minimum of three (3) years of case management experience
Collaborate with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.
Work with multidisciplinary team to assess and improve denial management, documentation, and appeals process.
Understand CMS medical necessity requirements and the coordination of care required under Federal and State regulations.
Identify opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.
At least five (5) years of nursing experience