- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is in person / on site. Please read below and ... 8am to 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse :** . **Review Medical Records:** Thoroughly evaluate patient… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review/ utilization management experience in an HMO, MSO, IPA, or health plan ... readability scoring + Knowledge of the appeals process + Experience with audit preparation + Basic computer skills UCLA Health is a world-renowned health… 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
- Molina Healthcare (Columbus, OH)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
- Ochsner Health (Lafayette, LA)
- …today!** This job applies clinical expertise as well as knowledge of utilization and discharge planning criteria to review medical information of prior hospitalized ... patients that are being reviewed via the regulatory audit process. Identifies issues and problems such as inappropriate admissions and non-acute hospital days which… more
- Molina Healthcare (WI)
- …be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have strong ... decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides… more
- Dignity Health (Bakersfield, CA)
- …from home** **within California** **.** **Position Summary:** The Delegation Management Nurse is responsible for overseeing and managing the delegation of healthcare ... high-quality care standards, and adhere to established contractual obligations. The nurse will work closely with clinical teams, providers, and third-party delegates… more
- Molina Healthcare (Columbus, OH)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… 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
- Sutter Health (San Francisco, CA)
- …manages capital and operational budgets to achieve financial targets via effective utilization of personnel, resources and supplies. Develops and maintains a solid ... concepts. *Ensures appropriate records are maintained for documentation and audit purposes. *Promotes efficient and effective communications between departments… 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
- Banner Health (Greeley, CO)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Banner Health (Torrington, WY)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Muckleshoot Indian Tribe (Auburn, WA)
- …instruct patients and their families how to perform necessary procedures. A Registered Nurse administers skilled nursing care to patients on an intermittent basis in ... in peer review and performance improvement as assigned. + Participates in utilization review of medical records as assigned. + Responsible for the orientation… more
- Banner Health (Brush, CO)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Banner Health (Ogallala, NE)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Texas Health Resources (Arlington, TX)
- ** Nurse Auditor - Clinical Billing Edits** _Bring your passion to Texas Health so we are Better + Together_ **Work location:** Remote **Work hours:** Monday - Friday ... and clinicians with education and feed-back to improve charging documentation and utilization management based on Medicare guidelines. * Analyze billing edits that… more
- Hartford HealthCare (Bloomfield, CT)
- …moment matters! What our nurses love about HHCAH: * Automatic enrollment into the Nurse Residency Program for all graduate RNs with less than one year of experience. ... management, infection control, outcomes and customer satisfaction and performs and uses audit results to lead development of Performance Improvement Plans. The QAPI… more