- CVS Health (Tallahassee, FL)
- …it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days ... other events, as directed by their Leader. **Required Qualifications** + Active and unrestricted Registered Nurse in state of residence + 3+ years of experience… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- * Remote in Hampton Roads* Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and ... resources as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of… 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
- Prometheus Federal Services (Glendale, CO)
- Registered Nurse ( RN ) -... consults / requests for completeness and appropriateness / utilization review . + Dispositioning care in the ... to federal health agencies, has an opening for multiple Registered Nurses. This position will perform administrative functions for...community per utilization review and guidelines. + Clinical review of… more
- Bon Secours Mercy Health (Greenville, SC)
- …utilizing the nurse triage algorithms. Assists with the evaluation and review of all incoming ambulatory oncology referrals and may be asked to assist ... are recognized for clinical and operational excellence. **This position will work remote , following an initial on-site training period (approx. 90 days). The work… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Mott Childrens Hospital- Child...Three (3) to five (5 ) years of psychiatric utilization review experience required. * Utilization ... Psych Partial Hospitalization Program) Apply Now **Job Summary** The Psychiatric Registered Nurse is responsible for initial assessments and management of… more
- Humana (Atlanta, GA)
- …supports the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will review prior authorization requests for appropriate ... or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will...using clinical judgment and refers to internal stakeholders for review depending on case findings. + Educates providers on… 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,.... Current and valid license to practice as a Registered Nurse (ADN or BSN) required. .… more
- Saint Francis Health System (Tulsa, OK)
- …to patient rooms \#RNSIND 3 - 12 hour shifts days/evenings Job Summary: The Registered Nurse I (Virtual) assesses, plans, implements and evaluates nursing care, ... works from an on-site office location (not a remote position) Will perform admit, discharge chart review...Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 5… more
- CVS Health (Denver, CO)
- …- 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
- CVS Health (Tallahassee, FL)
- …+ 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
- PruittHealth (Norcross, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... with long-term care population **MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:** * Licensed Registered Nurse with current, unrestricted license in state of… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …application. Former EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse ( RN ) is responsible for providing competent, ... orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary The Staff Registered Nurse , Office of Community Care Coordinator and Transition Manger is responsible for facilitating care provided in the community, ... care, participate in collaborative case and care management planning, utilization review and other related case and...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Saint Francis Health System (Tulsa, OK)
- …therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related ... pneumonia, CHF, PEC (pre-exiting conditions), and cardiac monitoring + Remote cardiac monitoring + Work closely as a team...units. + All private rooms Job Summary: The Clinical Nurse I assesses, plans, implements and evaluates nursing care,… more
- US Tech Solutions (Columbia, SC)
- **Job Description:** + Must be an RN in SC and have an active and unrestricted SC RN license. + Hours/Schedule - Monday-Friday 8:30am - 5pm. Remote position ... cost effective outcomes. **Responsibilities:** + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… more
- Ochsner Health (New Orleans, LA)
- …a difference at Ochsner Health and discover your future today!** This job is a registered Nurse with a diverse medical background, who is able to determine the ... Contents are subject to change at the company's discretion. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1 year… more
- Monroe Plan for Medical Care (Albany, NY)
- …HAS DIRECT REPORTS:NoESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function 75 Utilization Review Functions Perform utilization review ... Utilization Reviewer RN Summary Title: Utilization...to work independently.-Strong organizational skills.-Strong computer and typing skills PREFERRED: -Prior Utilization Review or Case Management… more
- Molina Healthcare (Everett, WA)
- …will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must ... be discussed during our interview process. This is a remote position. Illinois & Wisconsin RN compact...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review… more
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