Utilization review jobs in Hoboken, NJCreate job alerts

Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Bronx, New York. What do we do? Medical Solutions is one of the nation’s largest providers of total workforce solutions in the healthcare industry, connecting nurses and allied health clini...

Minimum of two (2) years utilization review/case management experience or social work experience.

Minimum of two (2) years utilization review/case management experience or social work experience.

Minimum of two (2) years utilization review/case management experience or social work experience.

Minimum of two (2) years utilization review/case management experience or social work experience. Licensed professional nurse may be considered. Commission for Case Management Certification (CCMC) or Association of Rehabilitation Nurses).

Minimum of two (2) years utilization review/case management experience or social work experience.

Conduct Utilization review via Chart Review. * Conduct timely concurrent reviews and responses to third party payors request for clinical reviews. * Work collaboratively with ED Case Managers and ...

Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift and mid shift Job types available: full time, part time, and per diem Employer features: Cross training ...

Coordinate with Utilization Management (UM) department on concurrent and retrospective review. Follow up with assigned nurses for clinical updates to care plan. Document within two business day ...

Actively participates in Quality Assurance/Performance Improvement and Utilization Review activities. * Conducts medical records audits, participates in needs analyses, oversees new/revised practices ...

Utilization Management * Participate in utilization review and management. * Maintain focus on key strategic priorities including patient experience, access to care, increased market share, and ...

A minimum of two years experience performing utilization review, claims adjudication, medical review, fraud investigation, surveillance or monitoring activities, required; OR * Three years of ...

The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and ...

Assess appropriate site of care utilization and continued medical necessity reviews for prior authorization to vendors. * Ensure communication with MD offices in relation to Site of Care program

Coordinate with Utilization Management (UM) department on concurrent and retrospective review. * Follow up with assigned nurses for clinical updates to care plan. * Document within two business day ...

... to ensure optimal utilization of services. * Ensure quality standards set by the external ... Provide ongoing review of emergency equipment, biological and medications in order to maintain ...

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...

Documents learning outcomes of patient/family and revises education plan Include utilization of EHR ... Engages in self assessment and peer review; utilizes resources to meet individual learning need and ...

... and utilization of referral services, as part of the health care system. Assists in providing ... Reviews and analyzes trends pertinent to delivery of nursing care services and collaborates with ...

The position also involves reviewing outcomes, coding, and utilization data to enhance participant health and reduce unnecessary utilization. Benefits * Medical, Vision, Dental, and Life Insurance

Review and interpret screening and diagnostic observations and report findings to the project ... Familiarity with database utilization, regulatory compliance and human subject's protection issues

Participates in helping to review and develop medical guidelines and policies geared toward quality ... Previous Utilization Management Experience in Acute Care Setting * Prior leadership experience ...

Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. * Responsible for all required network reporting and on-site state or federal ...

Participate in utilization and peer review programs which evaluates the quality of the medical staff and medical services being performed at the clinics * Provide supervision and consultation to ...