- Actalent (Atlanta, GA)
- Utilization Review - Registered Nurse Job Description This role involves performing precertification and medical necessity reviews for designated ... Benefits - Appeals, and Risk Management. Essential Skills + Registered Nurse (RN) with a valid license...+ Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Job… more
- Trinity Health (Langhorne, PA)
- …seeking an experienced Registered Nurse to join our team in Utilization Review ! The UM Registered Nurse is responsible for the coordinating and ... + CCM or Accredited Case Manager certification preferred. + Previous experience in Utilization review highly preferred. + Demonstrates ability to use problem… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating ... /*License/Certifications:*/ * Possession of a valid license as a Registered Nurse issued by the State of... issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)*… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor ( Registered Nurse / RN)** . This ... individual will be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an expert in the utilization review… more
- Veterans Affairs, Veterans Health Administration (Leavenworth, KS)
- …and analytical review of clinical information. Responsibilities The Revenue Utilization Review (RUR) Registered Nurse is under the supervision of a ... Summary The Revenue Utilization Review (RUR) nurse ...clinical registered nursing experience, experience with authorizations, utilization review , or insurance authorization experience; critical… 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
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Albany Medical Center (Albany, NY)
- …with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire - required ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… 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 (Lafayette, LA)
- …ability to meet productivity standards in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse (RN) ... care organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems (eg, JIVA) to efficiently document and assess patient cases.… more
- Ventura County (Ventura, CA)
- Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply Senior ... Registered Nurse - Hospital Management Utilization Salary $118,668.43...general and specialized principles, practices, techniques and methods of utilization review /management, discharge planning or case management.… 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
- 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 (Port Huron, MI)
- **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay Period:** 40 **Position Summary:** Responsible for determining the ... established SOP procedures. 9. Maintains current knowledge of hospital utilization review processes and participates in the...and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse (RN) ⦁ Bachelor's degree in… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point ... this position is able to cover a multitude of utilization review functions through point of entry,...management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure --… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Cognizant (Annapolis, MD)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- New York State Civil Service (Malone, NY)
- NY HELP Yes Agency Corrections and Community Supervision, Department of Title Registered Nurse 3 - Utilization Temp/Hourly Occupational Category Health Care, ... Possession of a license and current registration as a registered professional nurse in New York State;...clinical nursing experience of which one year was in utilization review and/or discharge planning.Substitution: a bachelor's… more
- YesCare Corp (Brentwood, TN)
- …Assist in completion of special projects on an as needed basis. **Key Qualifications:** + Registered Nurse (RN) active license + No less than 5 years' experience ... lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients...practice. + Facilitate quality health care intervention recommendations. + Review and assess over/under utilization issues. +… more