- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
- The County of Los Angeles (Los Angeles, CA)
- …INFORMATION: * An Utilization Review Nurse is an RN that has Case ...Los Angeles, a Utilization Review Nurse is an RN that has Case ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW … more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ... the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Review NurseJob Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to perform ... and experience. + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, including InterQual and Milliman Criteria.… more
- Actalent (Sunrise, FL)
- …of education and experience. + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, including InterQual and ... Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Ongoing mentorship, _development,_ and leadership programs + And more **Description** The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will ... be responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN Preceptor must be an expert in the utilization … more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... Patient Accounting Centers (CPAC) for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to… 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 ... case that surpasses expected LOS, expected cost, or over/under- utilization of resources. + Performs verbal/fax clinical review...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… 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, ... community VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases,...(may be extended up to two years on a case -by- case -basis.) NOTE: Grandfathering Provision - All persons… more
- LifePoint Health (Louisburg, NC)
- …a valid job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* ... Registered Nurse (RN) Utilization Review ...continued-stay days for patients. - Maintaining communication with the Case Management Department to facilitate timely discharge planning.. Reports… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care ... Hours per Week:1 Job Posting Category:NursingJob Posting Description:Department Summary: The UM Case Managers at Boston Children's review documentation within 1… more
- Ascension Health (Baltimore, MD)
- …health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and service ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Primary Responsibilities * Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review / case management/clinical/or combination; 2 of ... independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is… 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 ... **City/State:** Saint Louis, Missouri **Categories:** Case Coordination **Job Status:** PRN **Req ID** :...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… more
- Providence (Anchorage, AK)
- …Medical Surgical or Inpatient setting. + IRR or annual competency testing in Utilization Review . **Preferred Qualifications:** + Bachelor's Degree in Nursing or ... or Diploma in Nursing upon hire. + Alaska Registered Nurse License upon hire. + 2 years acute care...specialty. + 1 year experience in care management or utilization review in any setting or successful… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/212260/ case -manager%2c-rn utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- UNC Health Care (Raleigh, NC)
- **Description** **RN Utilization Manager needed to provide per diem coverage on weekends at UNC Rex and UNC Rex Holly Springs.** Become part of an inclusive ... episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...an acute hospital setting. At least 2 years of Utilization Management/ Case Management experience in a hospital… more
- Mount Sinai Health System (New York, NY)
- …influence other services by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data collection, data received ... efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management, care...Case Management and 6 years as a clinical nurse . + Previous supervisory experience in case … more