- Elevance Health (Morgantown, WV)
- RN Utilization Management / Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West ... Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review ) is...an equivalent background. + Current active, valid and unrestricted RN license to practice as a health professional within… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… 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
- AmeriHealth Caritas (Washington, DC)
- …Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse ( RN ) license in the District of Columbia in ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- Elevance Health (Woodbridge, VA)
- RN Utilization Review Nurse (Washington DC...is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review ... scope of licensure the District of Columbia is required. **Preferred Qualifications:** + Utilization Management / Review in managed care strongly preferred. +… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem… more
- Centene Corporation (Columbus, OH)
- …in either central or eastern time zone with experience in mental health settings and utilization management / review . * Department: PHCO BH UM supporting IL ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… 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 ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- AmeriHealth Caritas (Philadelphia, PA)
- …between 8:30a EST and 5:00p EST.** ; + Current, active, and unrestricted Registered Nurse licensure in Pennsylvania. + Associate Degree in Nursing. Bachelor ... 3 years of experience providing direct patient care;as a Registered Nurse working with medically fragile pediatric...a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… 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… more
- HCA Healthcare (Nashville, TN)
- …experience required + 1 - 3 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as a ... to join an organization that invests in you as a Utilization Review Services Registered Nurse ? At Parallon, you come first. HCA Healthcare has committed… more
- HCA Healthcare (Nashville, TN)
- …experience required + 1-4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as ... **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you...a registered professional nurse in the state in which he or she… more
- Baptist Memorial (Meridian, MS)
- … RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer setting ... Overview RN Utilization Review Weekender Job...Utilization Review Weekender Job Summary The Utilization Review Nurse is responsible for… more
- Baptist Memorial (Memphis, TN)
- Overview Job Summary The Utilization Review Nurse is...years of clinical experience RN with Case Management or Utilization Review experience ... medical necessity and appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers,… more
- Guthrie (Binghamton, NY)
- …services regarding admissions, case management , discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- Trinity Health (Columbus, OH)
- …information technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the ... of Medical Management . + Coordinates with the utilization review , case management , discharge...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… 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 ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Required** + Current license to practice as a Registered Nurse in the State of Utah,… more
- BriteLife Recovery (Englewood, NJ)
- …assigned What we need from you? + Minimum of 2-3 years of experience in utilization review , case management , or insurance coordination in a behavioral health ... What you will be doing? The Utilization Review (UR) Specialist is a...Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in… more