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Online Resumes with "Interqual Criteria"

Featured Profile

Healthcare Management Professional

I am looking for a position within the healthcare field where I can continue to expand my skills while making solid contributions. I offer over 15 years of progressive healthcare experience beginning with nursing and direct patient care continuing into roles including Hospice Team Manager and Admission Nurse, Branch Director for a proprietary home care agency, marketing/nurse liaison for a rehabilitation hospital. to each...

Ideal Companies: Humana, Blue Cross Florida, United Health Care, Daiichi Sankyo Inc., Metronics

Tags for this Online Resume: Registered Nurse, Hospice, Rehabilitation, Healthcare Sales and Marketing, Physician and Community Relations, Discharge Planning, Program Management, Business Development, Volume Expansion, Medicare and Medicaid CoPs, Recruitment, Training, Personnel Management, Admissions, Insurance Verifications, Scheduling, Forcasting, Staff Development, Customer Service, Nursing Assessments, Problem Solving, Quality and Compliance, Educator, Pediatrics, Teacher of Exceptional Student Education, Branch Director, Front Office Administrator, Account Managment, Case Management, Patient Advocate

Professional Health Insurance & Claims Adjuster

My ideal job in Health insurance is to achieve solid sales growth, and acquire new clients while maintaining current clients. As a claims adjuster I'm seeking opportunity to utilize my current experience with a company that is growing to provide me the opportunity to advance my skills.

Ideal Companies: I would like to work with any company that I can utilize my professional skills whether it's health insurance or claims adjuster that will offer stability and growth.

Tags for this Online Resume: claims adjuster, health insurance sales, worker comp, Property, Casualty, Interqual Criteria, IC-9, Xactimate, citizen certification

Utilization Review Nurse- 7 years experience

Continue working within the area of utilization review while using my nursing experience and clinical skills that I have already honed.

Tags for this Online Resume: medical review, clinical documentation, Medical policy & procedure, use of Interqual criteria, use of Milliman criteria, Medicaid and private insurance

Utilization Review RN

Rn with extensive managed care, utilization review/management, seeking a job in Utilization review. Also experienced in Interqual criteria and familiar with Milliman criteria as well as Medicare and Medicaid. I would like to become certified in UR or CM in the near future.

Featured Profile

RN, BSN with background in surgery, home health, case management

I am looking for a managerial position. I have done relief Surgical Services Manager. My school of nursing stressed leadership. I have a varied background in surgery, home health and case management.

Ideal Companies: Acute care hospitals, Post acute care company, Insurance company, EHR

Tags for this Online Resume: Surgical, Utilization and review, management, case management, teaching

clinical/non clinical RN, Tri-Cities, WA

full/part-time job using my skills and knowledge of triage and Interqual criteria

Tags for this Online Resume: Registered Nurse, part/full time, transfer center/call center, interqual criteria trained

Training Manager, Registered Nurse, Certified InterQual Instructor

Continued professional growth and achievement within an organization where InterQual Criteria training, medical claims training, CPT Coding training, SIU medical training, and medical consulting can be utilized to enhance fraud identification, improve medical claims handling and ensure the appropriate level of patient care is being delivered

PROBLEM SOLVER, Analytical Thinking

Tags for this Online Resume: spanis speaking, Interqual Criteria, Eclipsys

Certified Case Manager, Indianapolis, IN

Tags for this Online Resume: integrated case management, Stastics, Milliman Criteria, Interqual Criteria , Discharger Planning, Care Coordinating

Case Manager - 20 Years of Experience - up to 25 miles from 33176

NELLY GAZMEN CONROY, RN, BSN Cellular: (305) 926-0725 ------------------------------------------------------------------------------------------------------------------------ CAREER OBJECTIVE: A position in a progressive growing company which affords opportunities and advancement for motivated, hardworking, qualified ...

Tags for this Online Resume: Miami, Broward, Case Management, Director of Nursing, Teaching, Consulting, Computer, Gen Orientation

Registered Nurse - 17 Years of Experience - Near 33172

Ana B. Francisco RN BSN LNC LHRM 510 NW 109th Avenue, #5, Miami, Florida 33172 (786) 286-7160 W O R K E X P E R I E N C E: 2007-2009: DIRECTOR OF NURSING / ALTERNATE ADMINISTRATOR: Advantis Home Care, Inc., 2921 SW 8th St Miami, Florida 33135 Supervision of clinical and non-clinical staff operation; update of agency Policies and Procedures books, case management, utilization review, initiated the Quality Assurance ...

Ideal Companies: health care


Case Management Manager - 20 Years of Experience - Near 60409

I am a Nurse Case Management professional with upwards of 16 experience. My experience includes but is not limited to Telephonic Complex Case Management, Occupational Health/Worker’s compensation, and Psychiatric Nursing. Additionally, my proficiency with Utilization Review software, namely InterQual criteria and guidelines as well as Epic allows me the opportunity to make determinations on admissions, prior authorization, ...

Tags for this Online Resume: Utilization Review, ICD-9, Health Care Industry, Interqual, MCG, Communication Skills, Computer Aided Software Engineering, Patient Care, Coding, ICD-9, Health Care Industry, Management, Benefits, Communication Skills, Computer Aided Software Engineering, Patient Care, Utilization Review Nurse, Allscripts, Powerchart, Epic, EMR, CPT Codes