- Harris Regional Hospital (Sylva, NC)
- …the multidisciplinary team, payors, and community resources; leads discharge planning and utilization review activities. Reports to the Director or Manager of ... Registered Nurse (RN) - Case Manager Schedule: PRN, As...Protected Health Information Accessed: Demographic, Clinical, Insurance, Financial, Complete Medical Record. Exposure: Occupational exposure to bloodborne pathogens may… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, ... changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION II: ... UTILIZATION REVIEW NURSE SUPERVISOR...for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- Summary The Orlando VA Medical Center is seeking a Utilization Review Registered Nurse to join the Orlando VAMC team. The Utilization Review ... improvement and outcomes utilization consultation. Responsibilities The Utilization Review Registered Nurse leads the integration of evidence-based… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II...over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, ... Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... entry and concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …*_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness, and ... The RN conducts timely reviews of inpatient and outpatient medical records to determine the appropriateness of admissions, continued... issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)*… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse (37.5...third-party administrator files to oversee contractor handling; + May review medical records of various health care ... (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) is now hiring for the position of Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612XC&R1=&R3=) to… more
- YesCare Corp (Brentwood, TN)
- …standards of best practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. + Track, trend and ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...review parameters under the direction of the YesCare Medical Director. + Identify and document comparisons with community… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… 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 is responsible for ensuring the receipt ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use... Review prior authorization requests (prior authorization, concurrent review , and retrospective review ) for medical… more
- Independent Health (Buffalo, NY)
- …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: ( Medical necessity review … more
- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization… more
- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... management Assistants. 4. Reviews and documents findings on all medical necessity and status denials. 5. Works closely with...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Beth Israel Lahey Health (Burlington, MA)
- … medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with...necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted… more
- Dignity Health (Chandler, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the...For more than 50 years, Dignity Health's Chandler Regional Medical Center has focused on quality patient care and… more
- Ventura County (Ventura, CA)
- …the general and specialized principles, practices, techniques and methods of utilization review /management, discharge planning or case management. + utilize ... Senior Registered Nurse - Hospital Management Utilization Print... Center and Santa Paula Hospital. The Senior Registered Nurse -Hospital works collaboratively with a medical doctor… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative approaches ... Practical experience in the application of UM methods and expertise in medical necessity review criteria. This position requires strong analytical skills… more
- CVS Health (Austin, TX)
- …established goals and expectations. **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care ... And we do it all with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can… more
