- AmeriHealth Caritas (Washington, DC)
- …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
- HCA Healthcare (Nashville, TN)
- …of nursing experience required + 1 - 3 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed ... Do you want to join an organization that invests in you as a Utilization Review Services Registered Nurse? At Parallon, you come first. HCA Healthcare has… more
- HCA Healthcare (Nashville, TN)
- …years of nursing experience required + 1-4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently ... **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an… more
- 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
- 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 (Manhattan, KS)
- …time of the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . + ... **Details** + **Department:** Utilization Management + **Schedule:** FT Days;...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… 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
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse- Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... in a direct patient care clinical setting. Must have utilization management , utilization review...full, active, and unrestricted license to practice as a Registered Nurse as required in the TO Core Duties:… more
- Dartmouth Health (Lebanon, NH)
- Overview Utilization Management 30 hours per week Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. ... leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote * Area… 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
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- Summary The Utilization Management (UM) Registered Nurse (RN) is responsible for UM reviews for patients who receive hospital care. Responsibilities An UM ... Registered Nurse is responsible for UM reviews and use...accreditation standards, and performance measures. Uses emergency and bed management software and utilization data to manage… more
- McLaren Health Care (Pontiac, MI)
- …requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or ... **Position Summary:** Responsible for Utilization and Care Management services to...on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Utilization Management (UM) Consultant is a registered professional nurse, qualified by education and experience to work directly with ... social services, administrative officers, Emergency Department (ED) staff, and Bed Management . The nurse is responsible for applying clinical skills in reviewing,… 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 - Day ... + FTE:1 + Posted:May 15, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the… more
- Prime Healthcare (Weslaco, TX)
- …Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/ registered -nurse-case-manager utilization - management ... Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… 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
- Sedgwick Government Solutions (Charleston, SC)
- …+ Documents all utilization review outcomes in utilization review software. + Collaborates with case management , medical services, and the Medical ... Job Details Utilization Review Case Manager RN (Remote)...optimize health outcomes. + Escalates cases that may require review for certification, diagnostic services, or case management… more