- State of Connecticut, Department of Administrative Services (New Haven, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 250715-5612FP-001 Location New Haven, CT Date Opened 7/22/2025 12:00:00 AM Salary $78,480 - ... is seeking a highly motivated and compassionate U tilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) to join our team!… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …throughout the continuum of care. Responsibilities The Community Care (CC) Utilization Review Registered Nurse (RN) is responsible for collecting, interpreting, ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements,… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …& Patient Safety (QPS) Team! Responsibilities The Quality, Safety & Value (QSV) Peer Review Nurse Analyst completes and/or coordinates all aspects of the Peer ... and balanced. Maintains all documents and supporting evidence related to Peer Review , including Committee documentation and confidential communication back to… 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 NURSE ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- Geisinger (Danville, PA)
- …and procedures for accurate assignment, risk of mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of ... Job Summary The Clinical Documentation Improvement Program is designed to improve the...discharge. + Consistently meets established productivity targets for record review . + Identifies strategies for sustained work process changes… more
- Geisinger (Danville, PA)
- Job Summary The Clinical Documentation Improvement Program (CDI) is designed to improve the physician's documentation in the patient's medical record, supporting ... care of the patient. The role of the Clinical Documentation Improvement Specialist (CDIS) is to assist the providers...highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to… more
- Northwell Health (Lake Success, NY)
- **Req Number** 157409 Job Description Facilitates and obtains appropriate clinical documentation for all clinical conditions or procedures to support the appropriate ... discussions with physicians for clarification of ambiguous or conflicting documentation . Job Responsibility 1.Facilitates clarification of clinical documentation … more
- Cedars-Sinai (Los Angeles, CA)
- …Fair Chance Initiative for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days **Department** : ... Report has named us one of America's Best Hospitals. As our next Clinical Documentation Specialist, you will work under the general direction of the HID CDI/Core… more
- Trinity Health (Troy, NY)
- …opportunity for a Register Nurse ** Join our team as a Drug Regime Review Nurse for all Therapy Only admissions to homecare! The main responsibility for this ... and the provider/pharmacy with any discrepancies or findings. The nurse will review risks, and adverse reactions of medications and educate patient/caregiver… 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 ... concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation , medical guidelines, and… more
- CDPHP (Albany, NY)
- …Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes approval ... with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- US Tech Solutions (Chicago, IL)
- …with clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation . + Reviews ... experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff… more
- Actalent (San Antonio, TX)
- Job Title: Clinical Review NurseJob Description: The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical necessity ... requires following various procedures and processes to complete authorizations successfully. The nurse will collaborate with a team of nurses and communicate with… more
- US Tech Solutions (May, OK)
- …with clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation . . Reviews ... make recommendations to meet QM objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based.... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- CVS Health (Dover, DE)
- …a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and plan language or ... thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a… more
- UNC Health Care (Kinston, NC)
- …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, ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… 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 ... improvement of the UR KPI's. Ensures proper and accurate medical record documentation . **Essential Functions** + Reviews new admissions using 3rd party product for… more
- Ascension Health (Wichita, KS)
- **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs, Day shift, 7:30 AM- 4:00 PM, Monday-Friday, rotating weekends possible + ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- AmeriHealth Caritas (LA)
- …This role requires reviewing provider requests, gathering necessary medical documentation , and making determinations based on clinical criteria. Using professional ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health...Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +… more
- AmeriHealth Caritas (Washington, DC)
- …This role requires reviewing provider requests, gathering necessary medical documentation , and making determinations based on clinical criteria. Using professional ... When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to… more