- TulaRay (Frackville, PA)
- …nursing practices. Work is reviewed and evaluated by a Registered Nurse Supervisor, physician or dentist through observation, review of reports and ... Correctional Registered Nurse Correctional nurse ...nurses make assessments and decisions in regard to staff utilization and supplies and equipment needs. Charge nurse… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …as opportunities for improvement up the chain of command. Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:12 Hr Evening...physician advisor. Works collaboratively with the physicians, patient/family, nursing, utilization review and other members of the… more
- GHR Healthcare (Atlanta, GA)
- Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a ... Pay Rate: 37.50 -40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient services based on… more
- Blanchard Valley Health System (Findlay, OH)
- …Care Transitions Team, including the disciplines of Social Work, Case Management, Utilization Review , and Emergency Department Care Navigation to support ... during acute care stay. Duty 9: Maintains position as Utilization Review committee chair. Works in collaboration...service area. REQUIRED QUALIFICATIONS Current Ohio Licensure as a Registered Nurse Nursing experience 5+ years, 2-4… more
- Northeast Georgia Health System, Inc (Demorest, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:10 Hr Morning - EveningNortheast Georgia Health System is rooted in a foundation of improving the ... surgeries for: General, Gynecology, Orthopedics, Podiatry and ENT. Job SummaryThe Nurse Manager (NM) functions as the first-line administrative nursing leader, with… more
- Pacer Staffing (Atlanta, GA)
- …other duties as assigned. Regular and reliable attendance is required. Required: Registered Nurse , with current unrestricted license in appropriate state 4+ ... criteria required. Preferred: TRICARE experience Qualified for Certified Professional Utilization Review Certification or Certified Professional Utilization… more
- Medline Industries - Transportation & Operations (Northfield, IL)
- …state-specific requirements to practice:VA-BC (Vascular Access Board Certified)CRNI (Certified Registered Nurse of Infusion)CWOCN (Wound, Ostomy, and Continence ... growth within assigned targeted accounts.Conduct investigations, waste assessments, clinical review & observations for improved practice and best practice… more
- Pacer Staffing (Atlanta, GA)
- …state or territory of the United States, as a Licensed Clinical Social Worker or Registered Nurse US Citizenship Must be able to receive a favorable Interim and ... Job Summary: The position provides case management services for TRICARE beneficiaries registered in the Extended Care Health Option (ECHO) under TRICARE. The ECHO… 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 ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer ...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …whole health care to Veterans? Responsibilities The Utilization Management (UM) Registered Nurse ( RN ) executes position responsibilities that demonstrate ... application of UM methods and expertise in medical necessity review criteria. The UM RN is a...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- AmeriHealth Caritas (Dublin, OH)
- ** RN Clinical Care Reviewer , Concurrent Review , Utilization Management** Location: Dublin, OH Primary Job Function: Medical Management ID**: 34460 Your ... all information necessary to perform a thorough medical necessity review . It is within Clinical Care Reviewer ...and team driven environment! **Education/Experience:** + Must have OH Registered Nurse or compact state licensure. +… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under...ability to lead successful performance improvement projects. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- AmeriHealth Caritas (Charlotte, NC)
- ** RN Clinical Care Reviewer , UM, Exchange...of clinical practice experience as a Registered Nurse within acute care. + Utilization Management ... all information necessary to perform a thorough medical necessity review . It is within Clinical Care Reviewer ...**Education/Experience:** + Must be a graduate from an accredited Registered Nurse program. Diploma or Associate's Degree… more
- Ascension Health (Manhattan, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- CDS Life Transitions (Webster, NY)
- …regulations Education and Experience: + Bachelor's degree in Nursing + State licensure as a Registered Nurse ( RN ) + Minimum 2 years of prior experience in ... Summary: Utilization Management Reviewer (UR) is the...by supervisor. + Acts as Subject Matter Expert in Utilization Review and medical necessity criteria +… more
- University of Virginia (Charlottesville, VA)
- …2 years acute care hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. PREFERRED QUALIFICATIONS: ... Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a...in determining what cases to refer for second level review to external physician consultants and internal UVA UR… more
- Dartmouth Health (Lebanon, NH)
- …leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered Nurse with NH eligibility - Basic Life Support ... (BLS) Certificate required. * Remote:Hybrid Remote; * Area of Interest:Nursing; * FTE/Hours per pay period:.01 hrs/per week (per diem/temp); * Shift:Rotating; * Job ID:26030; Dartmouth Health is an Affirmative Action and Equal Opportunity Employer. All… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, August 5, 2024 Centers Plan for Healthy Living's goal is ... need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse Determinations or… more
- Commonwealth Care Alliance (Boston, MA)
- …requests from CCA Clinicians, Vendors and Providers. The UM Specialist reports to the Utilization Management Nurse Manager. **What You'll Be Doing:** + The UM ... Specialist reports to the Utilization Management Nurse Manager. + Uses established...RN staff to escalate decisions that require clinical review and oversight. + Communicates results of reviews in… more
- McLaren Health Care (Detroit, MI)
- …and implementing process improvement projects as needed. _Required:_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... accordance with established SOP procedures. 4. Maintains current knowledge of hospital utilization review processes and participates in the resolution of… more
