- LifePoint Health (Louisburg, NC)
- …**Please select a valid job field* **Organization:** **Maria Parham Franklin* **Title:** * Registered Nurse Utilization Review Coordinator* **Location:** ... Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Intermountain Health (Murray, UT)
- …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... and outpatient utilization to assure that care related to health insurance...applicable regulatory guidelines (NCQA, CMS, State) and ensures timely review with clear accurate communication to members and requesting… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Ongoing 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 … more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse ...level degree in Nursing may have opportunity to become registered as a nurse with a state ... the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle...improvements in patient care through systematic evaluation and analytical review of clinical information. Responsibilities Responsibilities of the RUR… more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …VA Greater Los Angeles Healthcare System (VAGLAHS) is seeking to hire experienced Registered Nurses to work in our Utilization Management (UM) Program. ... pertaining to patient flow. Responsible for focused studies of utilization patterns for the facility. Responsibilities Job duties include,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print...-OR- OPTION II: Two (2) years of experience as a registered nurse , of which one year must be ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 -...+ A current, active license to practice as a Registered Nurse issued by the California Board… 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, ... of types ofhealthcare services for which preauthorization or concurrent review will be required.Reviews previous and present medical care... Management is required. Full time employment as a registered nurse within the last 36 months… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 -… more
- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in nursing from accredited educational ... **Position Summary:** Responsible for Utilization and Care Management services to the Emergency...on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider… more
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... We are looking for a Utilization Management RN, to join us in leading...care, disease management and PCP treatment plans. Monitors member's utilization patterns for identification of high risk, and under… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure --...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- US Tech Solutions (Chicago, IL)
- …you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About ... + 3+ years of experience as an RN + Registered Nurse in state of residence +...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- AmeriHealth Caritas (Newark, DE)
- …(ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + An active compact state Registered Nurse (RN) license in good standing is required. + 3+ years ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- AmeriHealth Caritas (Washington, DC)
- …care, or medical office setting **Licensure** + Current driver's license required + A Registered Nurse (RN) license in the District of Columbia in good standing ... to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …for complex case discussions for all staff. Essential Qualifications * Current licensed Registered Nurse (RN) with state licensure. Must retain active licensure ... a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract...managed care setting. * 5+ years experience in clinical nurse setting preferred. * TPA Experience preferred. About At… more
- US Tech Solutions (May, OK)
- …years of experience as an RN . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization ... CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT… more
- UNC Health Care (Kinston, NC)
- …EXPERIENCE REQUIREMENT** + Five (5) years of health care experience as a Registered Nurse . **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a ... the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is...Registered Nurse in the state of North Carolina. **KNOWLEDGE, SKILLS… more