Utilization Review Nurse Jobs in San Antonio, Texas
13 San Antonio, TX Utilization Review Nurse jobs found on Monster.Jobs 1 to 13 of 13
JOB DESCRIPTION:Nurse, Case Manager II - CFHP POSITION CODE:4118 ESTABLISHED: 03/12 POSITION SUMMARY/RESPONSIBILITIES Oversees the allocation of resources, cost and quality of health care for identified chronically ill members of the Community First Health Plan. Coordinates care between the primary care physician, community resources, family and member. Coordinates care across the health care cont...
Description: Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines. The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescri...
This position will require 4-6 months of training in an office setting, after the training is complete this position can be remote. Expectation for All Employees Support the organization’s mission, vision and values by exhibiting the following behaviors: model integrity, embrace innovation, celebrate success, strive for excellence, focus on those we serve and foster trust. Job Purpose Perform medi...
Job Summary The Appeals/Denials Specialist II (job title) manages submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members and related outside agencies as a part of the integrated Healthcare Services Team. Conducts pertinent research, evaluates, responds and completes appeals and other inquiries accurately, timely and in accordance with all established...
JOB TITLE: Director, Clinical Services ? CFHP JOB CLASS NUMBER: 2883 CREATED: 02/13 ORGANIZATIONAL COMMITMENT A strong commitment to service excellence, positive clinical outcomes, cost efficiency, performance enhancement and high business ethics is required. Comprehensive knowledge in the area of specialty with a results oriented and patient-centered focus. Supports the strategic vision of the or...
JOB DESCRIPTION:Nurse Care Coordinator, Case Management - Ambulatory POSITION CODE:2067 REVISED:01/09 POSITION SUMMARY/RESPONSIBILITIES Analyzes, coordinates, and documents care coordination services for patients based on established criteria, plan policies and procedures. EDUCATION/EXPERIENCE Graduation from an accredited school of nursing, RN or LVN is required. A minimum three years of clinical...
JOB TITLE:Nurse, Case Manager II JOB CLASS NUMBER:4118 REVIEWED:11/12 POSITION SUMMARY/RESPONSIBILITIES Coordinates the interdisciplinary treatment plan of care for patients across the healthcare continuum within a defined population. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. E...
JOB TITLE:Nurse, Case Manager I ? Hospital Based JOB CLASS NUMBER: 4116 REVISED:10/08 POSITION SUMMARY/RESPONSIBILITIES Responsible for coordinating with the interdisciplinary treatment team a plan of care for patients across the healthcare continuum within a defined population. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to...
JOB DESCRIPTION:Nurse Case Manager - CFHP POSITION CODE:4117 (PRN 4121) REVIEWED: 03/12 POSITION SUMMARY/RESPONSIBILITIES Identifies Community First Health Plan members with specific health care needs. Formulates and communicates case management plans that efficiently utilize health care services to move the member along the continuum of care towards optimum outcomes in the safest, most cost effec...
POSITION SUMMARY: Manages submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members and related outside agencies as a part of the integrated Healthcare Services Team. Conducts pertinent research, evaluates, responds and completes appeals and other inquiries accurately, timely and in accordance with all established regulatory guidelines. Prepares appeal s...
JOB TITLE:Care Coordinator ? Access Coordination JOB CLASS NUMBER:2063 REVISED03/12 POSITION SUMMARY/RESPONSIBILITIES: At the front door of University Health System, this role serves to screen patients needing placement in acute or observation beds for the purposes of correct status determinations, and the coordination of appropriate diversions to home or other level of care more appropriate for t...
JOB TITLE:Documentation Improvement Coordinator JOB CLASS NUMBER:2084 REVISED:02/12 POSITION SUMMARY/RESPONSIBILITIES: Must be clinically competent in caring for assigned patient population. Must work collaboratively with all members of the healthcare team. Reviews patient information, screening the information through the appropriate review process for accurate and complete documentation of the c...
LifeSpan Home Health is now hiring for an In-House RN Supervisor! The RN In-House Supervisor utilizes the nursing process model to develop a holistic, multi-disciplinary approach to the plan of care involving the patient and family. This position requires a strong, hard-working, efficient individual. The RN Supervisor reports to the Director of Nursing and is responsible for being the glue that ho...
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Healthcare Career Tools
$53,600.00 - $103,400.00
Typical Salary for Nurse Manager in San Antonio
Source: Monster.com Careerbenchmarking Tool
Education / Training
Source: Monster.com Careerbenchmarking Tool
Promotes and restores patients' health by developing day-to-day management and long-term planning of the patient care area; directing and developing staff; providing physical and psychological support for patients, friends, and families.
Rate of Growth
Size of Industry in 2006:
Source: Bureau of Labor Statistics, May 2006
Maintains nursing staff by recruiting, selecting, orienting, and training nurses and auxiliary staff.
Maintains nursing operations by initiating, coordinating, and enforcing program, operational, and personnel policies and procedures.
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