- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care for ... to provide the best quality care. The Team The RN Utilization Management Reviewer is...against a license must be disclosed and reviewed + Registered nurses only, bachelor's degree in nursing (BSN) preferred… more
- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… 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 Ochsner's discretion. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse ( RN ) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound ... as an employee but as a person. As a registered nurse ( RN ) joining our...a valid job field* **Organization:** **Maria Parham Franklin* **Title:** * Registered Nurse Utilization Review… 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 ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse ( RN )** for a full-time position supporting the 2d Medical Group, ... of types ofhealthcare services for which preauthorization or concurrent review will be required.Reviews previous and present medical care... Management is required. Full time employment as a registered nurse within the last 36 months… more
- Community Health Systems (Naples, FL)
- …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition… more
- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... in St. Louis. + Have both Missouri and Illinois RN licenses. + If candidate only has one ...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse ...level degree in Nursing may have opportunity to become registered as a nurse with a state ... the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle...improvements in patient care through systematic evaluation and analytical review of clinical information. Responsibilities Responsibilities of the RUR… more
- HCA Healthcare (Houston, TX)
- …practice of nursing and improve positive outcomes for your patients as a Case Manager RN Registered Nurse . We want your knowledge and expertise! **Job ... and Qualifications** Under the direction of the Case Manager RN Registered Nurse and the...in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... job that may reasonably be required._ **Education/Experience Required:** + Current MA RN licensure + Bachelor's Degree in Nursing or advanced degree in healthcare… more
- HCA Healthcare (Kansas City, MO)
- …our nurses set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse RN Case Manager to join our healthcare family. **Benefits** ... their passion for patient care. Apply today for our Registered Nurse RN Case Manager...you will do in this role:** + Responsible for utilization review , discharge planning and care coordination… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), Case Management (per diem)Req #:0000191479 Category:Nursing Status:Per Diem Shift:Day Facility:Cooperman Barnabas Medical ... Hills Road, Livingston, NJ 07039 Job Title: Case Manager Registered Nurse ( RN ), Case Management...on other classifications of patients as designated by the Utilization /Case Management Review Plan. Coordinates patient care,… more
- Veterans Affairs, Veterans Health Administration (Cheyenne, WY)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge… more
- Penn Medicine (Lancaster, PA)
- …placement in position for incumbents who started after 07/01/2020. + A graduate registered nurse may only practice professional nursing under supervision and if ... the graduate registered nurse holds a current temporary practice... nurse is practicing. + All Clinical Nurse 1 RN 's will be required to… more
- AdventHealth (La Grange, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- Bassett Healthcare (Cooperstown, NY)
- …experience as a Registered Nurse , if experience is not relevant, Registered Nurse II must complete RN residency program, required License/ ... of safe patient care utilizing the nursing process. The RN assesses, plans, delivers, coordinates, integrates, and evaluates nursing...Certification: Current NYS license as a Registered Nurse , required BLS certification will be… more
- Penn Medicine (Lancaster, PA)
- …NCLEX within 60 days of starting in their RN role. + A graduate registered nurse may only practice professional nursing under supervision and if the graduate ... registered nurse holds a current temporary practice permit.... nurse is practicing. + All Clinical Nurse 1 RN 's will be required to successfully… more