- BayCare Health System (Clearwater, FL)
- …working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Nurse - Health Plan **Location** Clearwater:Park ... 2 years - Case Management + 2 years - Utilization Review + Directly working for Medicare...working for Medicare Advantage Plan - preferred **Facility:** BayCare Health System, Utilization Management-BHS **Location:** **Park Place**… more
- Pipeline Health System, LLC (Toast, NC)
- Job Title: Utilization Review Registered Nurse - Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse ... and compassionate care to our patients. This position is responsible for utilization review , assessment of discharge planning needs and coordination of… more
- 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 :...days per year + 11 paid Federal holidays + Health & Welfare allowance mostly cover the cost of… 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 ... CA Job Type Full time Job Number Y5126D Department HEALTH SERVICES Opening Date 06/08/2020 + Description + Benefits...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General… 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 ... (https://portal.ct.gov/dds/searchable-archive/northregion/north-region/welcome-to-the-north-region?language=en\_US) - is accepting applications for a full-time Utilization Review Nurse Coordinator… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 241023-5612FP-001 Location Middletown, CT Date Opened 11/5/2024 12:00:00 AM Salary $78,480 - ... Families (DCF (https://portal.ct.gov/dcf) ), seeks qualified individuals for a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) position.… 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 a team responsible for ... Join Martin's Point Health Care - an innovative, not-for-profit health...retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use… more
- Ascension Health (Manhattan, KS)
- … health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality care ... for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines +… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …of communication with clinic, payor and other customers. **Job Title: Licensed Vocational Nurse Utilization Review -** ** Utilization Management-Sign on ... **Responsibilities** The Utilization Review LVN nurse ...by joining our team today and changing the way health cares. **Why Kelsey-Seybold Clinic?** + Medical, Vision, and… 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 ... compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work experience.… more
- Travelers Insurance Company (Buffalo, NY)
- …**What Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for ... do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual...to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**… 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 ... Description Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to… more
- US Tech Solutions (Columbia, SC)
- … health /chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years must ... Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit… more
- CVS Health (Sacramento, CA)
- …+ Candidates in PST preferred + 1+ years experience in either Precertification or Utilization Review highly preferred + 1+ years experience Managed Care + Strong ... Bring your heart to CVS Health . Every one of us at CVS ...care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is… more
- CVS Health (Hartford, CT)
- …in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record ... Bring your heart to CVS Health . Every one of us at CVS ...and affordable. **Position Summary** This is a full-time remote Utilization Management Nurse Consultant opportunity. Utilization… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …the healthcare continuum. Performs other duties as assigned. The ED-UM RN performs utilization review activities, ensuring appropriate level of care and status ... Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN)...on all patients reviewed in the ED. Conducts initial review using InterQual, and other tools, and assists provider… 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 ... Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews… more
- CVS Health (Austin, TX)
- …setting **Preferred Qualifications** + Experience working with the Medicare population + Utilization review experience + Managed Care experience **Education** + ... Bring your heart to CVS Health . Every one of us at CVS ... care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work schedules will… more
- Elevance Health (Tampa, FL)
- …managed care industry strongly preferred. + 2 years of experience in In-Patient, utilization review / management, evaluating medical necessity for services and ... RN Utilization Management Nurse Sr. (Medicaid-InPatient) JR130851...include, but are not limited to: + Continued stay review , care coordination, and discharge planning for appropriateness of… more