- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- Elevance Health (Mason, OH)
- ** Nurse Audit Senior - Payment Integrity Complex and Clinical Audit ** **Location:** This role enables associates to work virtually full-time, with the ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Nurse Audit Senior** will be responsible for identifying, monitoring,… more
- CVS Health (Boise, ID)
- …a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring, ... meet client needs. Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management, concurrent… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… more
- Corewell Health (Southfield, MI)
- Scope of Work This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities ... adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status… more
- Trinity Health (Des Moines, IA)
- …Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient admission records ... STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is approved based on… more
- Ochsner Health (Lafayette, LA)
- …or other related MCO departments/functions. **Certifications** Required - Current registered nurse (RN) license in state of practice. *MSW accepted in lieu ... of registered nurse (RN) licensure. Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare Management (CPHM). **Knowledge Skills… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... as an employee, but as a person. As a*registered nurse (RN)*joining our team, you're embracing a vital mission...outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of… more
- Molina Healthcare (Oakland, CA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... agreement. Preservice and outpatient experience. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more
- MyFlorida (Marianna, FL)
- REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - ALL SHIFTS) Date: Jul 29, 2025 The State Personnel System is an E-Verify employer. For more information ... No: 844947 Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - ALL SHIFTS) Pay Plan: Career… more
- Molina Healthcare (Midvale, UT)
- **JOB DESCRIPTION** _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This position ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Elderwood (Lake Placid, NY)
- Salary $74,000 to $96,525 / year Overview RN - MDS Nurse Assessor Pay Rate Range:$74,000 - $96,525 / year (Earn more with experience!) NEW:Gas Allowance Benefit for ... Full-time and Part-time positions Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment and reimbursement… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Coordinator, Oncology Clinical Research Full Time, 80 Hours Per Pay Period, Day Shift Thompson Cancer Survival Center Overview: Thompson ... treat - and beat - the disease. Position Summary: The Clinical Research Nurse Coordinator promotes good clinical practices in the conduct of oncology clinical trials… more
- STG International (Temple, TX)
- STGi is currently seeking a Pharmacy Nurse -Licensed Vocational Nurse to provide services at The William R. Courtney Texas State Veterans Home. The William R. ... drug regimen and report irregularities to DON 15. Randomly audit drug storage and medical supply areas to ensure...care in pharmacy ordering, alternative substitutions and off formulary utilization . 25. Participates as a team member in the… more
- CommuniCare Health Services Corporate (Cincinnati, OH)
- …and targets for utilization + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization , ... Registered Nurse (RN), Mobile MDS Coordinator CommuniCare Health Services is currently looking for a Registered Nurse to fill the key position of RN Mobile MDS… more
- Banner Health (Phoenix, AZ)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... Internal Medicine and Family Practice. As aL **icensed Practical Nurse ** on our team, we offer a customer-focused and...care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the… more
- Wellpath (Santa Rosa, CA)
- …training, education, and point of care support. **How you make a difference** The Nurse Practitioner provides a full range of medical services for inmates. They work ... and procedures for infirmary admissions, emergency room transfers, and the utilization review process for specialty referrals while maintaining responsibility for… more