- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM ... (https://portal.ct.gov/dds/searchable-archive/northregion/north-region/welcome-to-the-north-region?language=en\_US) - is accepting applications for a full-time Utilization Review Nurse Coordinator… more
- Houston Methodist (Houston, TX)
- …intensive. This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist ... At Houston Methodist, the Sr Utilization Review Specialist Nurse ...to mitigate denials. + Collaborates with department leadership and revenue cycle partners regarding any claim issues or concern… more
- Emory Healthcare/Emory University (Decatur, GA)
- …development _,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / ... be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an...as well as an in depth understanding of the revenue cycle as a whole. + Will demonstrate foresight… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more **Description** We're seeking an **Inpatient Registry Utilization Review Nurse (PRN)** who is responsible for conducting ... physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and...as a liaison between the clinical care team, the revenue cycle, and the patient to ensure the continuity… more
- Beth Israel Lahey Health (Burlington, MA)
- …necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case ... necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case… more
- Omaha Children's Hospital (Omaha, NE)
- …opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management ... Guides admitting physician in protocols for conducting physician to physician review with third-party payers. o Appropriately documents all relevant communications… more
- Omaha Children's Hospital (Omaha, NE)
- …opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management ... Guides admitting physician in protocols for conducting physician to physician review with third-party payers. * Appropriately documents all relevant communications… more
- Saint Luke's (Kansas City, MO)
- **Job Description** The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization ... using clinical guidelines (InterQual). + Complies with CMS regulation regarding utilization review /management. + Obtains and manages insurance authorizations and… more
- Guthrie (Binghamton, NY)
- Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and ... a variety of concurrent and retrospective UM-related clinical reviews and revenue cycle functions ensuring appropriate status and corresponding reimbursement. The UM… more
- Swedish Health Services (Seattle, WA)
- …to be considered_** **Care Manager RN** **Per diem / On call** **Day shift** The Utilization Review (UR) Nurse has a strong clinical background blended with ... a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …a Certified Professional Coder required. + Three to five years of case management utilization review , or compliance related work experience in a hospital setting ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete… more
- Virtua Health (Pennsauken, NJ)
- …team members including UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- CareFirst (Baltimore, MD)
- …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... appeals, billing coordination, and clinical support. + Manages the analysis of utilization patterns, such as demographics of service, revenue , and expenditures… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …or related field * Minimum 3 years of experience in clinical care, utilization review , case management, or clinical denials/appeals -OR- * An approved ... *_SUMMARY:_* We are currently seeking a Utilization Management Analyst to join our Denials Analysis. This full-time role will primarily work remotely, but may need… more
- Montrose Memorial Hospital (Montrose, CO)
- …the medical care provided. This position combines the unique skill sets of the Utilization Review Nurse and Clinical Documentation Specialist to facilitate ... of healthcare. About the "Department" + Montrose Regional Health revenue integrity is the auditing and active monitoring to...experience preferred; and one (1) to two (2) years Utilization Review experience preferred. What We Offer:… more
- HCA Healthcare (Kansas City, MO)
- …satisfaction and personal growth, we encourage you to apply for our Operating Room Nurse PRN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as an Operating Room Nurse you want with your current employer? We have...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Kansas City, MO)
- …is important to you, we encourage you to apply for our Operating Room Nurse opening. Our team will promptly review your application. Highly qualified candidates ... their positions. Join our Team as an Operating Room Nurse and access programs to assist with every stage...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- State of Georgia (Fulton County, GA)
- …experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes and/or ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot… more
- McLaren Health Care (Flint, MI)
- …years clinical nursing experience. + One (1) year previous case management or utilization review experience. **Preferred:** + BSN. + Two (2) years' experience ... regarding managed care, disease management and PCP treatment plans. Monitors member's utilization patterns for identification of high risk, and under and overuse of… more
- University of Miami (North Miami, FL)
- …position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Accountabilities ... and applicable certifications and professional practice standards. Responsible for the utilization and maintenance of appropriate nursing care plans and assessment… more