- Geisinger (Wilkes-Barre, PA)
- Job Title: RN - Graduate Registered Nurse (Geisinger Wyoming Valley, Wilkes-Barre)Location: Wilkes-Barre, PennsylvaniaJob Category: Inpatient RN - Registered ... Nurse , Nursing and Nursing SupportSchedule: Rotation Work Type: Full...and Nursing SupportSchedule: Rotation Work Type: Full timeDepartment: Talent Management Nursing & Nursing Support TeamDate Posted: 04/29/2025Job ID:… more
- GIBSON AREA HOSPITAL (Gibson City, IL)
- …Full Time Salary Range $32.00 - $48.00 Hourly Description JOB TITLE: UTILIZATION REVIEW /CASE MANAGEMENT - Nurse DEPARTMENT: CASE MANAGEMENT (QUALITY) ... GENERAL SUMMARY The Utilization Review /Case Management Nurse is directly responsible for review of patient admissions for severity of illness and… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …to perform discharge planning and utilize interqual criteria - Experience in utilization review and concurrent reviews Description: This position requires ... Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day 5x8-Hour… more
- Aveanna Healthcare (Birmingham, AL)
- …the plan of care and patient needs. Participates in quality improvement, utilization review , and infection control activities as requested. Attends appropriate ... $7500 Sign-On Bonus Position Overview: The Hospice Registered Nurse is responsible for pain management , symptom control in the delivery of care to hospice… more
- PharmaCord (Jeffersonville, IN)
- …Bachelor's degree required; Master's degree is preferred Nurse line triage, Call Center Utilization Management , Call Center Case Management a plus Case ... financial forecast Prepares activity summary for the development and review of client monthly invoices Team selection, hiring, training...management or Clinical Trial Nurse experience, a plus Previous personnel/team management … more
- SR International, Inc. (Phoenix, AZ)
- …Skills Required: *Medical nursing practice, medical case management protocols, quality management and utilization review protocols as related to all ... pertaining to the AHCCCS program *Good written and communication skills *Computer skills * Utilization Review skills *Medical Claims Review skills *Producing… more
- George C. Grape Community Hospital (Hamburg, IA)
- Utilization Review & Chronic Care Management (CCM) Nurse George C. Grape Community Hospital & Clinics is seeking a full-time Utilization Review & ... this position, you'll split your time between: * Hospital Utilization Review - Conduct daily face-to-face rounds...ensure documentation supports medical necessity. * Clinic Chronic Care Management - Work with patients who have multiple chronic… more
- CVS Health (Salt Lake City, UT)
- … (RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have ... procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to… more
- Actalent (Des Moines, IA)
- Job Title: Post Review Nurse - Utilization Management Job Description We are seeking a diligent and detail-oriented Post Review Nurse to perform ... + Perform other duties as assigned. Essential Skills + Utilization management and utilization review experience. + Acute care expertise. + Knowledge of… more
- Actalent (San Antonio, TX)
- Clinical Review Nurse ( Utilization Management ) 100% Remote Job Description The role of the Utilization Management Nurse involves performing ... Perform concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate...Bachelor's or Associate's degree in Nursing. + Texas Registered Nurse License. + Strong multitasking and time management… more
- The County of Los Angeles (Los Angeles, CA)
- …may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge is ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...of Los Angeles, a Utilization Review Nurse is an RN that has Case Management … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.8 FTE ... needs and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator Office/On-site Recruitment # 250910-5613FP-001 Location East Hartford, CT Date Opened 9/15/2025 12:00:00 AM Salary ... (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
- 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 ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… 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...preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care… 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** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem ... Registered Nurse II/III - Utilization Management ...as needed to assist with patient care coordination and utilization review . The incumbent will be responsible… more
- Dayton Children's Hospital (Dayton, OH)
- …timeHours:8Job Details:Under the supervision of the Manager of Utilization Management , the Utilization Review RN conducts medical record ... guidelines and communicates information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource to the physicians,… more
- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
