- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... quality of medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and over- utilization … more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- Centene Corporation (Jefferson City, MO)
- …of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required ... flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to… more
- CVS Health (Jefferson City, MO)
- …care. - Perform medical necessity reviews. **Required Qualifications** - 5+ years' experience as a Registered Nurse (RN) 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 (Jefferson City, MO)
- …+ 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
- Sharecare (Jefferson City, MO)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... and high level of communication skills to ensure appropriate utilization of and reimbursement for resources from admission through...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- ChenMed (St. Louis, MO)
- … and discharge planning. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of Utilization Review (UR) and discharge planning + Strong interpersonal and ... a related clinical field preferred + A valid, active Registered Nurse (RN) license in State of...experience required + A minimum of 1 year of utilization review and/or case management, home health,… more
- Evolent (Jefferson City, MO)
- …are applied appropriately. **Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing (Must be ... , you will be a key member of the utilization management team. We can offer you a meaningful...a Registered Nurse ) + Strong interpersonal and communication… more
- HCA Healthcare (Kansas City, MO)
- …is important to you, we encourage you to apply for our Operating Room Nurse opening. Our team will promptly review your application. Highly qualified candidates ... their positions. Join our Team as an Operating Room Nurse and access programs to assist with every stage...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, evaluates, and ... and related software applications and implementations. + Engages in utilization review committee. Qualifications + Master's Degree...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- CenterWell (Creve Coeur, MO)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + OASIS proficiency required; HCHB… more