- Medical Solutions (Omaha, NE)
- Take control of your career with this Case Management ( Utilization Review ) in RN ( Registered Nurse) job in Baltimore, MD. Enjoy freedom, flexibility, and ... industry-leading service from a company that truly cares. Whether you're...to make sure it's amazing! Our travelers enjoy top-tier service from their own dedicated recruiter, thousands of jobs… more
- Zenex Partners (Torrance, CA)
- Description Job Opportunity: Registered Nurse - Utilization Review Facility: Providence SoCal Shared Services Case Management Location: Torrance, CA ... Employment Type: Travel/Contract Shift: Day (5x8 Hours) 8:00 16:30 Start Date: 3/3/2025 Job Duration: 13 weeks Compensation: Rate Type: Hourly Over Time: 8 regular hours in a day OR 40 regular hours in 1 week: 1.3% Double Time: None On-Call: 15$ Call Back:… more
- Lifepoint Health (Louisburg, NC)
- Description Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound ... as an employee but as a person. As a registered nurse (RN) joining our team, you're embracing a...the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate… more
- BridgePoint Healthcare (Washington, DC)
- …and discharge planning. Case Management, RN Case Manager, RN CCM, RNCM, RN CM, Utilization Review , Hospital Case Management, Registered Nurse Case Manager ... throughout the continuum of care and ensures optimum utilization of resources, service delivery, and compliance with external review agencies. The RN Case… more
- County of Los Angeles, CA (Los Angeles, CA)
- …questions concerning the necessity for utilization review , and develop review procedures. Determines need for and conducts in- service training to improve ... Job Type: Full time Job Number: Y5125L Department: HEALTH SERVICES Opening Date: 05/21/2025 Position/Program Information EXAM NUMBER Y5125L...One year of experience performing the duties of a Utilization Review Nurse* or Medical Service… more
- AmeriHealth Caritas Health Plan (Washington, DC)
- …to efficiently document and assess patient cases Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... compliance Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment The range displayed in this job… more
- Northwestern Memorial Healthcare (Lake Forest, IL)
- …the ability to work with minimum supervision Past experience in admissions, utilization review activities, discharge planning, and/or case management Preferred: ... Monitors and documents avoidable days and recommends change in services or processes. Responds to requests by the denials...Utilization Review experience Masters of Science Nursing Membership in Professional… more
- Baptist Health Care (Gulf Breeze, FL)
- Job Description The Utilization Review Nurse acts as a patient and organizational advocate. An autonomous role that coordinates, negotiates, procures services ... of resources across the continuum of care. The Utilization Review Nurse assists the nurse case...years broad based nursing experience Required Licenses and Certifications Registered Nurse Licensed State of Florida or eligible compact… more
- Kaiser Permanente (Santa Cruz, CA)
- Description: Eligible for Sign on bonus! Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in ... the discharge planning process. Essential Responsibilities: Conducts utilization review for in-house patients and/or members who have been admitted to contracted… more
- Prime Healthcare Management Inc (Ontario, CA)
- …working for a Health Plan. At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. Current BCLS (AHA) certificate ... cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity,...an accredited school of nursing and a current state Registered Nurse license. Minimum 3 years RN Utilization… more
- Ochsner Health (New Orleans, LA)
- …hospital-based experience in discharge planning, case management or utilization review . Certifications Required - Current registered nurse license in state ... to change at the company's discretion. Education Required - Registered nurse diploma or equivalent. Preferred - Bachelors degree...of the conditions of participation as it relates to utilization review and discharge planning. Maintains open… more
- UnitedHealth Group (San Antonio, TX)
- …letters to provider and member May provide guidance and coaching to other utilization review nurses and participate in the orientation of newly hired ... of the Optum family of businesses, is seeking a Registered Nurse RN Medical Claims Review Healthcare...50-state license) 2+ years of experience in managed care, Utilization Review , Case Management OR 5+ years… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …delegating/coordinating staff assignments and promoting staff development. Responsible for the utilization and continued review of patient care protocols, ... treatment modalities that others replicate across the country. Our services include a state-of-the-art psychiatric urgent care center and...and community settings. What Will You Do? As a Registered Nurse at Pine Rest, you'll be part of… more
- Veterans Health Administration (San Francisco, CA)
- …period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP ... Summary The Telemetry Registered Nurse is accountable for all elements of...education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrating leadership in delivering and improving holistic… more
- Methodist Health System (Omaha, NE)
- …or handling excreta from patients who have received hazardous medications. 9. Review , delegate and evaluate plans for appropriate utilization of staff ... Demonstrate ability to identify opportunities for and give individualized customer service /patient care according to customer/patient needs. 2. Perform an initial… more
- Sutter Health (Burlingame, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of ... patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services , third party payers and review agencies, claims and… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- … review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services , payors, and community providers. Track ... department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse (RN) with a… more
- NYULMC (New York, NY)
- …top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter ... Summary: We have an exciting opportunity to join our team as a Registered Nurse, Pediatric/Neonatal Transport, Per Diem. In this role, the successful candidate… more
- Accede Solutions, Inc. (Glendale, CA)
- Registered Nurse - Case Management Duration:13 Weeks Start:03/10/2025 Job Type: Travel Minimum Guaranteed Hours: 40 Jobs Notes: Day Shift, inpatient RN CM Acute ... Planning. We are comprised of a 515-bed hospital, two urgent cares, home care services , comprehensive cardiology care and a vast scope of services . Job Summary:… more
- Atlantic Health System (Morristown, NJ)
- …Develops the plan of care for the patient and family Ensures appropriate utilization of services Maintains visit productivity standards Demonstrates knowledge of ... interdisciplinary communication Performs HHA supervisions per standards Ensures appropriate utilization of services Follows scheduling process Communicates… more
