- 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 ... to see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether… more
- Martin's Point Health Care (Portland, ME)
- …as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as is responsible for ensuring the receipt of ... necessity reviews for retrospective authorization requests as well as claims disputes.The Utilization Review Nurse will use appropriate governmental policies… 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 ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
- 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 ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
- Independent Health (Buffalo, NY)
- …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… 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 ...Registered Nurse (RN) Utilization Review Job Type: Full Time...our team. In addition to your base compensation, this position also offers: * Medical, Dental, and Vision coverage… more
- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... that are integral to our mission. EO/AA_ + This position is responsible for maintaining the financial integrity of...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... to your community _Benefit options and eligibility vary by position . Compensation varies based on factors including, but not...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
- Intermountain Health (Murray, UT)
- …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... and outpatient utilization to assure that care related to health insurance...applicable regulatory guidelines (NCQA, CMS, State) and ensures timely review with clear accurate communication to members and requesting… more
- UNC Health Care (Kinston, NC)
- …the health and well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care ... 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
- Prime Healthcare (Ontario, CA)
- …-lvn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc LocationUS-CA-Ontario ID2024-176615 CategoryLVN/LPN Position ... Plan. Qualifications Required qualifications: + Possess an active CA Licensed Vocational Nurse (LVN) license. + Minimum two years of experience in acute hospital… more
- Calvert Memorial Hospital (Prince Frederick, MD)
- …of Maryland, required. + Experience : + Minimum 2 years in clinical nursing, utilization review , and/or case management. + Other Requirements : + Maintains ... for all insurance payers, facilitating medical peer to peer review requests. + Education : + Position ...peer review requests. + Education : + Position requires a Bachelor's Degree in Nursing (BSN). +… 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 ... This is a great opportunity for a local remote position . **Schedule** PRN (As needed) + Shifts will fall...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… more
- Baptist Memorial (Meridian, MS)
- …Job Description Title: RN Utilization Review Weekender Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity ... and appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... (inpt vs OBS). Facilitates concurrent reviews and authorizations for admissions. This position will support the development of policies and procedures, standard work… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care...Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent… more
- Commonwealth of Pennsylvania (PA)
- …I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or ... Closing Date 6/5/2025 11:59 PM Eastern Job Code 30440 Position Number 00045832 Union Non Union Bargaining Unit P3...Work Behavior as a charge nurse , head nurse , utilization review nurse… more
- Ascension Health (Manhattan, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... to your community _Benefit options and eligibility vary by position . Compensation varies based on factors including, but not...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... to your community _Benefit options and eligibility vary by position . Compensation varies based on factors including, but not...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- Ascension Health (Tulsa, OK)
- …planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance ... to your community _Benefit options and eligibility vary by position . Compensation varies based on factors including, but not...hire. **Additional Preferences** + 5+ years RN experience + Utilization Review experience preferred **Why Join Our… more