- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW :...clinical information and may also provide education on the medical review process. + The Contractor performing… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II...over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, ... Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,161.60 - $176,872.80… more
- Trinity Health (Springfield, MA)
- …Type:** Part time **Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** ... using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization ...and their families. **What you will do** + Perform utilization review and payer notification + Establish… more
- Travelers Insurance Company (Albany, NY)
- …Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, ... do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview**...to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for… more
- Catholic Health Initiatives (Little Rock, AR)
- **Overview** As a Utilization Review nurse with CHI St Vincent Little Rock, you'll work with physicians, other registered nurses, specialized departments, ... from records and maintains statistics. + Monitors and tracts Medicare denials, works with medical records to review third party payor denials. + Works with other… 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 ... UCLA Health. You will play a key part in promoting high-quality, cost-effective medical care by applying clinical acumen and applicable policies and guidelines in… more
- Matrix Providers (Aurora, CO)
- …Quality and Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP) + Certified Informatics Nursing, Ambulatory ... Registered Nurse (RN) - Utilization Management Location:...care clinical setting and 12 months consecutive experience in utilization management, utilization review or… more
- CVS Health (Harrisburg, PA)
- …experience is in behavioral health) **Preferred Qualifications:** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care -Strong ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the… more
- CVS Health (Columbus, OH)
- …term care, orthopedics, and more) **Preferred Qualifications:** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care -Strong ... to make health care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is fully remote and… more
- LA Care Health Plan (Los Angeles, CA)
- …Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review . Monitors and oversees the collection and transfer of ... Utilization Management Nurse Specialist RN II...inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, member/family… more
- Ascension Health (Tulsa, OK)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... professional licensure at time of hire. **Additional Preferences** + Strong Utilization Review experience + Exceptional communication skills + Leadership… more
- CVS Health (Carson City, NV)
- …in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... ( utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization. + Required to use a residential broadband… more
- CVS Health (Columbus, OH)
- …personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days **including ... and UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience in ER, triage, ICU,… more
- CVS Health (Raleigh, NC)
- …for candidates who reside in EST or CST + Managed Care experience + Utilization review experience **Education** + Minimum of Associates Degree in Nursing ... and affordable. **Position Summary** **This is a fully remote Utilization Management opportunity.** Utilization management is a...Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN… more
- System One (Baltimore, MD)
- …benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, ... is staffing a contract to hire opportunity for a Utilization Management Nurse to support a leading...determination of appropriateness and authorization of clinical services both medical and behavioral health. Pay: $46/HR 90% Remote May… more
- University of Virginia (Charlottesville, VA)
- …to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed ... Under general direction: The Utilization Management RN serves as a leader resource...accordance with the mission vision and values of UVA Medical Center. + Analyze and evaluate complex medical… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital at Home ... and holiday rotations required **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care...-Case Manager experience as well as Utilization Review experience ( review medical necessity… more
- Elevance Health (Washington, DC)
- The Utilization Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member ... medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and… more