- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Some positions may require specialized certifications(s). **Title:** * Staff Nurse - Utilization Review (Float)* **Location:** *MN-Minneapolis-Downtown ... *_SUMMARY:_* We are currently seeking a* Staff Nurse *to join our Utilization...may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse … more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to...new or revised procedures. + Works with Professional Standards Review Organization representative to orient new staff … more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... medical direction, administrative and technical supervision over the nursing staff engaged in utilization review ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Houston Methodist (Houston, TX)
- …intensive. This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist ... At Houston Methodist, the Sr Utilization Review Specialist Nurse ...members. + Serves as the primary information resource for utilization management staff , payers, physicians, and other… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM ... (https://portal.ct.gov/dds/searchable-archive/northregion/north-region/welcome-to-the-north-region?language=en\_US) - is accepting applications for a full-time Utilization Review Nurse Coordinator… more
- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: ... Idaho! We are currently seeking a dedicated and experiencedRegistered Nurse Seniorto take on a critical role in our... Seniorto take on a critical role in our Utilization Review , Performance Improvement, Nursing Education programs.… more
- Emory Healthcare/Emory University (Decatur, GA)
- …development _,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / ... be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an...department. This will consist of regular audits of each staff member which will assist with identification in knowledge… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... collaboration with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services.… more
- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...7. Assists in the orientation and precepting of professional staff and colleagues as assigned. 8. Participates in analyzing,… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...at the appropriate place and time + Mentors new staff into case management role as assigned. + Assumes… 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 Required** + ... excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion,...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Dayton Children's Hospital (Dayton, OH)
- Facility:Dayton Children's - Main CampusDepartment: Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of ... Utilization Management, the Utilization Review ...acute care indicators and criteria as approved by medical staff , Joint Commission, CMS, and other agencies. Prospectively, concurrently,… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - ... Duties This position is in the Utilization Review Unit and functions as an assessment nurse...to, and works under the general supervision of a Nurse Manager, or other higher-level staff member.… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... Data gathering requires navigation through multiple system applications. + Staff may be required to contact the providers of...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue...level of care.. 5. Collaborates with case managers, nursing staff , coding team , the physicians and finance… more
- Justice, Bureau of Prisons/Federal Prison System (Rochester, MN)
- …Department of a Bureau of Prisons, Medical Referral Center (MRC). Serves as the Utilization Review Nurse and assists in quality improvement activities ... to the appropriateness of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... or recommendation. . Data gathering requires navigation through multiple system applications. . Staff may be required to contact the providers of record, vendors, or… more
- CVS Health (OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... team and serves as a vital resource for both staff and leadership. While this role does not include...practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided at the ... right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Ventura County (Ventura, CA)
- …Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation ... Per Diem Registered Nurse II/III - Utilization Management VCMC...needs; + Communicates the plan to physicians, patients, family/caregivers, staff and appropriate community agencies; + Reviews, monitors, evaluates… more