- Ochsner Health (New Orleans, LA)
- …experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in state of ... and implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will be ... responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN Preceptor must be an expert in the utilization review … 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 VCMC Salary $109,727.64 - $184,627.89...as needed to assist with patient care coordination and utilization review . The incumbent will be responsible… more
- Ascension Health (Wichita, KS)
- …time of the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . + ... **Details** + **Department:** Utilization Review + **Schedule:** Full time,...coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment ... select a valid job field* **Organization:** **Maria Parham Franklin* **Title:** * Registered Nurse Utilization Review Coordinator* **Location:**… more
- Ascension Health (Baltimore, MD)
- …the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . ... **Details** + **Department:** Utilization Management + **Schedule:** Part-time. Monday-Friday,...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …members of the interdisciplinary team. Responsibilities Duties include but not limited to: Utilization Review (UR) Registered Nurse (RN) is responsible for ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care....level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to… more
- AdventHealth (Tampa, FL)
- …and other diseases. **The role you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical ... review as determined by department standards. The Utilization Management Nurse is accountable for a...need to succeed:** + Associate's of Nursing Required + Registered Nurse (RN) license Required + 3 years of… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print...Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... + FTE:1 + Posted:July 14, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Barnstable counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more
- Beth Israel Lahey Health (Burlington, MA)
- …team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience ... Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …customer satisfaction throughout the continuum of care. Responsibilities The Community Care (CC) Utilization Review Registered Nurse (RN) is responsible for ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards,...level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... this position is able to cover a multitude of utilization review functions through point of entry,...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more