- Novo Nordisk Inc. (New York, NY)
- …evolve, so does our challenge to find better and more innovative ways to improve their quality of life. We're changing lives for a living. Are you ready to make a ... relationships include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, diabetes educators, pharmacists, blood bank staff, organized… more
- UT Health Tyler (Tyler, TX)
- …for coordinating the care and service of patients across the continuum promoting quality care, effective utilization of resources and assuming a leadership role ... to $20,000 Join our team as a full-time, day shift, Case Manager Registered Nurse in Tyler, TX. Fulfilling your purpose begins here: People First, Always. Here's how… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This position ... + Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Commonwealth of Pennsylvania (PA)
- …professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an ... performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an industrial, employee… more
- Justice, Bureau of Prisons/Federal Prison System (TX)
- …3 facility, or Federal Correctional Complex (FCC). Serves as the Utilization Review Nurse and assists in quality improvement activities through data ... to the appropriateness of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to… more
- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization ... requiring clinical review prior to payment. The Utilization Review Nurse will use...time. + Mentors new staff as assigned. + Maintains quality audit scores within department standards. + Maintains productivity… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40...medical care delivery and reimbursement systems; + Participates in utilization review and/or quality assurance ... is seeking a highly motivated and compassionate U tilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) to join our team!… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a team responsible ... for ensuring the receipt of high quality , cost efficient medical outcomes for those enrollees with...retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use… more
- Health First (Melbourne, FL)
- …personal vehicle. **Job:** **Case Management* **Organization:** **Holmes Regional Medical Center* **Title:** * Utilization Review Nurse - Case Management UR ... *POSITION SUMMARY* The Utilization Review (UR) nurse ...be exposed to inside environments with varied temperatures, air quality , lighting and/or low to moderate noise. * Communicating… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …+ Adaptive to a high pace and changing environment. + Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity...+ Provides referrals to Case management, Disease Management, and Quality Department as needed. + Develop and review… more
- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform...to ensure accurate clinical data. + Adhere to established quality , timeliness, and productivity outputs required in the completion… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... development and ongoing implementation of QM Work Plan activities. . Improve quality products and services, by using measurement and analysis to process, evaluate… more
- University of Washington (Seattle, WA)
- …) **UW Medical Center - Northwest** has an outstanding opportunity for an **experienced Utilization Review Nurse ** to join our team. **WORK SCHEDULE** + ... POSITION QUALIFICATIONS** + 3 years of work experience in utilization management + 5 years of nursing work experience...training + Active licensure to practice as a Registered Nurse in Washington State + Knowledge of medical screening… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... Management/Social Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health ... more at UCLA Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …VA Healthcare System, Louisville, Kentucky is currently recruiting for a Registered Nurse - Utilization Management in Quality and Patient Safety Louisville, ... Kentucky 603. Responsibilities The Nurse Ill Utilization Management (UM) Registered ...application of UM methods and expertise in medical necessity review criteria. This position requires strong analytical skills and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… more
- CVS Health (Raleigh, NC)
- …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... deliver solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and… more
