- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...cover the cost of health insurance, long and short-term disability , and life insurance + Dental and vision plans… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) position, located… more
- State of Georgia (Thomas County, GA)
- Registered Nurse (Regional Quality Review (RQR)) - Region 4 Georgia - Thomas - Thomasville ... located in downtown Atlanta. Job Description Job Title: Registered Nurse ( Regional Quality Review (RQR) )...of individuals making application to and seeking continuing developmental disability services. . Registered Nurse will provide… 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 NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, concurrent,… more
- UPMC (Hanover, PA)
- **UPMC is hiring a Professional Care Manager to support the Utilization Review process! This is a full time, day shift position with a rotating weekend and holiday ... schedule.** This is a nonpatient-facing position. This Registered Nurse is responsible for completing medical necessity reviews utilizing Indicia and InterQual… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - Utilization Review Nurse - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case ... Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work experience. Preferred: + Associate… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- Actalent (Dallas, TX)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests to determine the ... healthcare providers and the authorization team to ensure timely review of services and/or requests. + Assess the medical...years of related experience. + LPN - Licensed Practical Nurse - State Licensure required. + Clinical knowledge and… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the appropriateness of clinical ... care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing...of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License. + BLS Sedentary… more
- Ascension Health (Manhattan, KS)
- …plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- Centene Corporation (Nashville, TN)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- US Tech Solutions (May, OK)
- …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior...knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT… more
- Centene Corporation (Sacramento, CA)
- …that requires California RN Licensure. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of ... quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and clinical… more
- Actalent (Chicago, IL)
- Job Title: HEDIS Review SpecialistJob Description - Will be calling out to providers and doctors' offices to retrieve medical information and ask any follow-up ... provider clean-up. - Will be part of the HEDIS team during the Jan-May season. Review medical records from all 5 states. Abstracting 6 medical records per hour. Data… more
- Centene Corporation (Sacramento, CA)
- …race, color, religion, sex, sexual orientation, gender identity, national origin, disability , veteran status, or other characteristic protected by applicable law. ... Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act more
- Bassett Healthcare (Cooperstown, NY)
- …discuss specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Emergency Department is accountable for the ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. Registered Nurse I: The RN I status is only appropriate for a new nurse… more
- State of Colorado (Denver, CO)
- Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections ... Medical Operations Coordinator ( Nurse V) Salary $108,540.00 - $151,968.00 Annually Location Denver...provides support for performance evaluations. This role also includes review and implementation of preventive health care services, program,… more
- Commonwealth of Pennsylvania (PA)
- …I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an ... with a mental or physical injury, illness, or developmental disability ; or + Six years of professional nursing experience,...Work Behavior as a charge nurse , head nurse , utilization review nurse , quality… more