- UNC Health (Chapel Hill, NC)
- UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job in Chapel Hill, North Carolina.Job Description & RequirementsSpecialty: Care ... we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the Hedrick building and is 100%… more
- InnovaCare (San Juan, PR)
- …customer focus to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the ... Inpatient within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily basis, concurrently reviews… more
- Centene Corporation (Cheyenne, WY)
- …based on diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Provides education to providers on… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This position reports to the ... at any time with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level determination… more
- RWJBarnabas Health (Jersey City, NJ)
- Nurse Midwife(FT) Days- MMG Concurrent -Jersey CityReq #:0000106025 Category: Nurse Midwife Status:Full-Time Shift:Day Facility:Jersey City Medical Center ... Department:MMG Concurrent Location: Jersey City Medical Center, 355 Grand Street,...Street, Jersey CIty, NJ 07302 Job Overview- The Certified Nurse Midwife position provides antepartum, intrapartum, postpartum, neonatal and… more
- Sharp HealthCare (San Diego, CA)
- …Medical-Surgical Nursing, and/or Home Health. + 1 Year Utilization Management/ Concurrent review experience. + California Registered Nurse (RN) - CA Board of ... **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing… more
- Beth Israel Lahey Health (Burlington, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three payments. You… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... completing inpatient level of care reviews, post-acute care initial and concurrent reviews for acute and subacute rehabilitation, transportation and DME requests.… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization Review Team and ... clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies...also review prior authorization requests (prior authorization, concurrent review , and retrospective review )… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, … more
- Glens Falls Hospital (Glens Falls, NY)
- …hours per week, can be foundhere. **Job:** **Nursing - Case Management* **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On ... * * *How You Will Fulfill Your Potential* *Responsibilities* * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ) medical necessity… more
- University of Utah Health (Salt Lake City, UT)
- …continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues ... cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Ascension Health (Saginaw, MI)
- …health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned ... unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement...team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, member/ ... Utilization Management Nurse Specialist LVN II Job Category: Clinical Department:...if indicated. Perform telephonic and/or on site admission and concurrent review , and collaborates with onsite staff,… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department:...workplace environment. Perform telephonic and/or on site admission and concurrent review , and collaborates with onsite staff,… more
- HCA Healthcare (Las Vegas, NV)
- …clinical data compiled by hospital medical records for the purpose of admission/ concurrent review for Medicare and self-pay patients + Identifies potential ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...and apply today! + You will be performing admission review to determine appropriateness and medical necessity based on… more
- Baystate Health (Greenfield, MA)
- …to **Baystate Franklin Medical Center** is looking for a **Per Diem** **Registered Nurse (RN), Case Manager** to join our Hospital Case Management team in ... close to home. **SCHEDULE:** + Per Diem **MINIMUM QUALIFICATIONS:** + MA Registered Nurse License + American Heart Association BLS CPR + Minimum 3 years acute… more
- Rush University Medical Center (Chicago, IL)
- …the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director ... **Shift:** **Shift 1** **Work Schedule:** 10 Hr **Summary:** The Nurse Care Manager 1 works with physician practices and...regarding Case issues and concurrent denials an indicated. 6. Applies pathways/guidelines, assesses variances,… more
- Sacramento County (Sacramento, CA)
- Psychiatric Nurse Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/981663) Apply Psychiatric Nurse Salary $108,283.68 - $119,370.96 ... Note: For additional nursing opportunities please see Registered Nurse DCF Level I/II (https://www.governmentjobs.com/careers/sacramento/jobs/454059/registered- nurse -dcf-level-i-ii?keywords=registered%20nurse&pagetype=jobOpportunitiesJobs) ,… more
- UNC Health Care (Rocky Mount, NC)
- …services will be reimbursed and denials minimized. The Point of Entry UR nurse will work with patients presenting in the Emergency Department and/or Operating Room. ... and third-party payer regulations and guidelines. Collaborates with in-patient Utilization Review RNs and Case Managers to ensure efficient throughput from hospital… more
