- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… 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
- Veterans Affairs, Veterans Health Administration (Cheyenne, WY)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... from the community VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for… more
- AmeriHealth Caritas (Newark, DE)
- …ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday, 8:00 AM ... Nursing (BSN) preferred. + An active compact state Registered Nurse (RN) license in good standing is required. +...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... 10th Floor, Washington DC 20024 + Availability to work Monday through Friday, 8:00 AM to 5:00 PM, flexible...ability to meet productivity standards in a fast-paced, high-volume utilization review environment The range displayed in… 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
- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... **Schedule** PRN (As needed) + Shifts will fall between Monday -Friday 8 am - 4:30 pm with assigned Sunday...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… 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 4 years ... **Job Description:** + Monday -Friday, 8am-4:30pm or 8:30am-5pm panel interviews on ms...promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… 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, Barksdale ... ERP is an Equal Opportunity Employer - Disability and Veteran. **Responsibilities** **Schedule:** Monday - Friday, 9 hours between 7:00am and 5:00pm, with a one-hour… more
- CVS Health (Sacramento, CA)
- …the first 3 weeks on camera training required 100% participation during 8:30am-5pm Monday -Friday. * A Registered Nurse that must hold an unrestricted license ... every day. **Position Summary** Fully remote role in the USA. **Requires Monday -Frida** y: 11:30am-8:00pm EST shift; 8:30am-5:00pm PST; or 9:30-6:00pm MST depending… more
- CVS Health (Carson City, NV)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... all with heart, each and every day. **Schedule** : Monday -Friday (11:30am-8:00pm EST Hours; Shift times may vary based...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- CVS Health (St. Paul, MN)
- …and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/ review experience preferred Outpatient Clinical experience. +… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by… more
- Nuvance Health (Danbury, CT)
- …other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required : ... Time Hours : 20 Shift: 8:30am-5:00pm Thursday/Friday (1st week) Monday /Tuesday/Wednesday (2nd week) ; rotate one weekend per month...one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the… more
- Centene Corporation (Oklahoma City, OK)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... perspective on workplace flexibility. **Work Schedule:** Tuesday through Saturday **Training Schedule:** Monday through Friday, 8:00 AM - 5:00 PM for the first month… more
- CVS Health (Charleston, WV)
- …RN with experience in psychiatric setting required Preferred Qualifications: + Managed care/ utilization review experience preferred + Experience in a behavioral ... compassionate. And we do it all with heart, each and every day. ** Utilization Management Clinical Consultant** **Remote - West Virginia** Schedule is Monday… more
- CVS Health (Columbus, OH)
- …and trainings to New Albany Office in OH. **Preferred Qualifications** + Managed care/ utilization review experience preferred + Experience in a behavioral health ... Summary** The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This… more
- Actalent (Dallas, TX)
- Job Title: Review Nurse Job Description The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical necessity for ... various procedures and processes to complete authorizations successfully. The nurse will collaborate with a team of nurses and...Skills + Experience in utilization management, concurrent review , prior authorization, utilization review ,… more
- Centene Corporation (New York, NY)
- …an active, unrestricted New York State nursing license.** **8:30am-5pm, Monday -Friday Eastern Standard hours.** **Position Purpose:** Analyzes all prior ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Veterans Affairs, Veterans Health Administration (Leavenworth, KS)
- …potentially long periods of continued sitting and computer use and typing. The Revenue Utilization Review Nurse must be a mature, flexible, sensible ... Summary The Revenue Utilization Review (RUR) nurse ...license from any US State or territory Work Schedule: Monday - Friday 8:00am- 4:30pm Compressed/Flexible: Available at supervisory… more