- Baylor Scott & White Health (Dallas, TX)
- …least (3) three years of professional experience is required. + You must hold a valid Registered Nurse License ( RN ). As a health care system committed to ... vary based upon position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service suitability. You'll educate… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director, the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical ... enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that...Required: + BSN or MSN degree + Active CA RN License + Minimum of 2 years' experience in… more
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- Vanderbilt University Medical Center (Nashville, TN)
- … Hybrid - after 4-6 months depending on performance Previous case management, utilization review , or discharge care experience a plus . KEY RESPONSIBILITIES + ... instead of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC- Registered Nurse - Licensure-Others **Work Experience:** Relevant… more
- Bassett Healthcare (Cooperstown, NY)
- …needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a ... hire. + Salary Range: $39.01- $58.51 per hour + Registered Nurse II: The RN ...as measured by periodic random preceptor and supervisory chart review as per probationary appraisal schedule + ( RN… more
- HCA Healthcare (Austin, TX)
- …of Austin we support our colleagues in their positions. Join our Team as a(an) Registered Nurse Case Manager and access programs to assist with every stage of ... gain certifications and job skills. Apply today for our Registered Nurse Case Manager opening and continue...Nurse Case Manager opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more
- Rochester Regional Health (Rochester, NY)
- …and was named among the top 10% in the nation for cardiology services. SUMMARY: As a Registered Nurse ( RN ), you're the engine and the heart of patient care ... Support (BLS) certification PREFERRED QUALIFICATIONS + Acute care, chart review , utilization , or nursing triage experience strongly...Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse -… more
- HCA Healthcare (Round Rock, TX)
- …at St. David's Round Rock Medical Center! **Job Summary and Qualifications** **The Registered Nurse ( RN ) CM is responsible for promoting patient-centered ... discharge plan in collaboration with the multidisciplinary team. The RN CM facilitates the progression and transition of care...encourage you to apply for our Registered Nurse Case Manager opening. We review all… more
- Vanderbilt University Medical Center (Tullahoma, TN)
- …status is ordered. The nurse conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review ... difficulty. + Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business… more
- Actalent (Sacramento, CA)
- Job Title: Appeals and Grievances Registered Nurse Job Description We are seeking a skilled professional to join our team and handle member appeals and ... receive appropriate care. This position reports directly to the Nurse Manager and plays a key role in providing...prior authorization, pre-service and post-service review , appeals, utilization management, utilization review , and… more
- Trinity Health (Maywood, IL)
- …campus. Position is hybrid , must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the multidisciplinary ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer-...management, typing and communication skills are necessary. + Current Registered Nurse License State of Illinois +… more
- Robert Half Accountemps (Boston, MA)
- …seeking RNs to step into impactful non-clinical roles - including chart review , clinical auditing, utilization management, quality assurance, and case ... Description Now Hiring Registered Nurses (RNs) - Ready for a Change...standards + Full-time, Monday-Friday schedule (potential for remote or hybrid ) + Must have an active RN … more
- Humana (Augusta, ME)
- …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review ....15 associates. **WAH Internet Statement** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive… more
- Centene Corporation (Raleigh, NC)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Centene Corporation (Phoenix, AZ)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... health. + Proficiency in clinical and utilization review processes. + Current unrestricted Florida RN ...medical record software. Work Environment This position offers a hybrid work schedule, with in-office work in Sunrise on… more
- Texas Health Resources (Arlington, TX)
- … Management required 3 years previous leadership experience required Licenses and Certifications RN - Registered Nurse Current license to practice ... Director Utilization Management-Clinical Review _Are you looking...+ Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote/onsite. Vast majority of time will be remote,… more
- Centene Corporation (Columbus, OH)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... **This is a remote position open to candidates nationwide.** **Candidates must have a Registered Nurse ( RN ) license for California and ability to work… more
- Fallon Health (Worcester, MA)
- …in nursing required** **License/Certifications** + Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience** + A minimum of three ... Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review ...to five years clinical experience as a Registered Nurse in a clinical setting required.… more