- UNC Health Care (Kinston, NC)
- …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... Coordinates and leads all clinical denial processes and clinical audit activities. Collaborates with teammates involved in the denial...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review,… more
- Elevance Health (Atlanta, GA)
- …is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Nurse Audit Senior** will be responsible for identifying, monitoring, ... ** Nurse Auditor Senior - Payment Integrity Complex and Clinical Audit ** **Location:** This role enables associates to work virtually full-time, with the… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...teams to execute our strategic plan for AwareUM. + Audit for product accuracy and effectiveness, communicating with product… more
- TEKsystems (Los Angeles, CA)
- …This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong ... understanding of HMO/Medicare claims processes. Key Responsibilities: + Audit denied provider and member claims for accuracy and compliance + Review and process… more
- McLaren Health Care (Mount Pleasant, MI)
- …6. Provides support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process are met, including ... sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within ... the Utilization Management (UM) program to maximize efficiency, ensure compliance...the pre-authorization management team. Develops, updates, and maintains systematic audit tools to measure compliance with UM Standard Operating… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
- Immigration and Customs Enforcement (Washington, DC)
- …clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing ... needed interpretation and/or translations services are available. d. The correctional registered nurse practices ethically per the Code of Ethics for Nurses with… more
- Northern Rivers Family Services (Queensbury, NY)
- …collaborate with county and community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, ... Type Full Time Travel Percentage Up to 25% Category Nurse Description Psychiatric Nurse Practitioner - Assertive Community Treatment New Hire Retention Bonus… more
- Molina Healthcare (Rio Rancho, NM)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + ... of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and… more
- Banner Health (Worland, WY)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... patients undergoing treatments. This role is best suited for an experienced nurse or an eager nurse wanting to grow into the role for this specialty. **BLS… more
- CentraCare (St. Cloud, MN)
- …Job Schedule: Full time CentraCare is looking for a qualified Clinical Documentation Nurse to join our team! This role is responsible for concurrent auditing of ... medical record documentation to evaluate the documentation and utilization review of services to adequately reflect care provided and resources used.… more
- State of Georgia (GA)
- …Specialist 3 - Registered Nurse Georgia (https://ga.referrals.selectminds.com/jobs/75386/other-jobs-matching/location-only) New Hot Regulatory Corrections, Georgia ... treatment facilities, regulated entity operations and program management + Conducts utilization reviews, peer reviews, evaluation activities and all other reviews on… more
- Trinity Health (Columbus, OH)
- …setting preferred. + Demonstrated ability to analyze, summarize and concisely report medical utilization , and medical chart audit results. + Ability to compare ... wide variety of professional roles including information technology, financial analysis, audit , provider relations and more. **Position Purpose:** The RN Case… more
- Banner Health (Phoenix, AZ)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... facilities in the Phoenix Metro area. Exemplars mentioned from the American Nurse Credentialing Center included the robust nursing succession planning and the… more
- HCA Healthcare (Richmond, VA)
- …We care like family! Jump-start your career as a Clinical Research Nurse today with Chippenham Hospital. **Benefits** Chippenham Hospital offers a total rewards ... for benefits may vary by location._** Come join our team as a Clinical Research Nurse . We care for our community! Just last year, HCA Healthcare and our colleagues… more
- HCA Healthcare (Port Charlotte, FL)
- …We care like family! Jump-start your career as a Clinical Research Nurse today with HCA Florida Fawcett Hospital. **Benefits** HCA Florida Fawcett Hospital ... for benefits may vary by location._** Come join our team as a Clinical Research Nurse . We care for our community! Just last year, HCA Healthcare and our colleagues… more
- Banner Health (Greeley, CO)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Banner Health (Scottsdale, AZ)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Wellpath (Coal Township, PA)
- …training, education, and point of care support. **How you make a difference** The Nurse Practitioner provides a full range of medical services for inmates. They work ... and procedures for infirmary admissions, emergency room transfers, and the utilization review process for specialty referrals while maintaining responsibility for… more