- Conifer Revenue Cycle Solutions (Frisco, TX)
- …(2) years supervisory experience CERTIFICATES, LICENSES, REGISTRATIONS Preferred: Active state Registered Nurse license or Certified Coding Specialist credential ... annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding… more
- Martin's Point Health Care (Portland, ME)
- …preferred + 3 years of medical management experience in a managed care setting including utilization review + RN experience in a clinical setting required + ... 2015. Position Summary The Supervisor is responsible for day-to-day operations of the utilization review team, which includes clinical and non-clinical staff, in… more
- HonorHealth (AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... Nurse in an acute care setting - Required Licenses and Certifications + Registered Nurse ( RN ) State And/Or Compact State Licensure - Required +… more
- Penn Medicine (Philadelphia, PA)
- …rewarding and ** REMOTE RN ** role! This role will focus primarily on utilization review which is why **we are seeking individuals who have between 3 to ... assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...and offerings. Education/Experience: + Unrestricted state license as a Registered Nurse required; BSN preferred. + 3+… more
- Henry Ford Health System (Warren, MI)
- …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse with a valid, unrestricted State of Michigan License.… more
- CVS Health (KY)
- …it all with heart, each and every day. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant. **Must reside in the state of ... Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse ( RN ) with active...schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population… more
- CVS Health (OH)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Team Lead plays ... 5+ years of clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Cognizant (Carson City, NV)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Bon Secours Mercy Health (Springfield, OH)
- …clinical and operational excellence. **Summary of Primary Function** In the capacity of a Registered Nurse ( RN ), the Ambulatory Care Manager will provide ... of care to ensure medically appropriate cost-effective care. This is primarily a remote /work at home position, but hire should live driving distance from Columbus,… more
- CVS Health (MI)
- …the case management system to organize cases dealing with disease management and utilization review ; tracks patient progress and manages specific conditions. + ... providers. Serves as advocate for patients, ensuring effective communication, resource utilization , and continuous monitoring of their progress to promote positive… more
- CVS Health (MO)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Saint Francis Health System (Tulsa, OK)
- …from ER, ICU, and CTU units. + All private rooms Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the ... therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related… more
- Actalent (Sacramento, CA)
- Job Title: Appeals and Grievances Registered Nurse Job Description We are seeking a skilled professional to join our team and handle member appeals and ... receive appropriate care. This position reports directly to the Nurse Manager and plays a key role in providing...prior authorization, pre-service and post-service review , appeals, utilization management, utilization review , and… more
- Tufts Medicine (Burlington, MA)
- …coordinates the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's ... the utilization of resources, coordination of care across the continuum and utilization review and management. The position develops and leads the … more
- Providence (Mission Hills, CA)
- …empower them. **Required Qualifications:** + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Experience working in a ... Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse… more
- Robert Half Accountemps (Boston, MA)
- …seeking RNs to step into impactful non-clinical roles - including chart review , clinical auditing, utilization management, quality assurance, and case ... Description Now Hiring Registered Nurses (RNs) - Ready for a Change...Be the Right Move for You: + Use your RN skills in a fresh environment + Apply your...remote or hybrid) + Must have an active RN license and at least 2 years of clinical… more
- AdventHealth (Altamonte Springs, FL)
- … **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing patient ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...carrier. **The expertise and experiences you'll need to succeed:** RN - Registered Nurse -… more
