- Luminis Health (Lanham, MD)
- Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and ... and denial of payment. Essential Job Duties: 1. Chart Review : Reviews the medical record by applying utilization... : Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization;… more
- University Hospitals (Cleveland, OH)
- …activities based on Voice of the Customer (VOC) service needs and expectations. Review care of patients ( concurrent and retrospective) to assess for ... RN, Neurosurgery - Main Campus (25000A1P) A Brief Overview The Senior Improvement Nurse serves as a strategic partner, responsible for facilitating on behalf of the… more
- Centene Corporation (Des Moines, IA)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Concurrent Denial Nurse , you will support the Utilization Management Department by ... criteria is met. We are looking for a Registered Nurse who is a subject matter expert in utilization...to the department in general and the hospital. + Review and analyze concurrent and retrospective clinical… more
- Cedars-Sinai (Los Angeles, CA)
- …Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge ... Short Stay cases and assists with real-time management of concurrent payer denials. + This role ensures timely, accurate,...Coordination **Req ID** : 14355 **Working Title** : Registered Nurse -Utilization Review Case Manager - 8… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/Utilization Review Nurse Position Summary: The Quality/Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of patient… more
- UNC Health Care (Kinston, NC)
- …the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria ... of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service,...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,… more
- Centene Corporation (Jefferson City, MO)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine… more
- University of Utah Health (Salt Lake City, UT)
- …continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues ... cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Actalent (Atlanta, GA)
- …(Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In this role, ... Job Title: Utilization Review RN Location: Buckhead, GA (on-site position) Schedule:...experience. + BLS and CPR certifications. + Experience with concurrent , prospective, and retrospective reviews. + Familiarity with case… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of network and medical… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department:...productive workplace environment. Perform telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff,… more
- Alameda Health System (San Leandro, CA)
- …concurrent reviews assigning acute, administrative and denied days as per ACBH concurrent review policy. 23. Utilizes clinical knowledge and defined standards ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management...the appropriate admit status and medical necessity for admission, concurrent , and discharges, securing the appropriate documentation and planning… more
- Rush University Medical Center (Chicago, IL)
- …the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director ... depending on the circumstances of each case. **Summary:** The Nurse Care Manager 1 works with physician practices and...regarding Case issues and concurrent denials an indicated. 6. Applies pathways/guidelines, assesses variances,… more
- Hartford HealthCare (Manchester, CT)
- …or assign other duties and responsibilities to this position * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ), Milliman Care Guidelines ... Hospital, a 102-bed facility, a large multispecialty provider group and visiting nurse services. The Greater Manchester Region serves a region of 300,000 people… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse D/CF Salary ... on: 12/1/25, 2/2/26, 4/6/26, 6/1/26, 8/3/26, 10/5/26, 12/7/26 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory class in… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 4/3/2026, 7/2/2026, 10/2/2026 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties,… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... pm on: 9/4/2025, 11/6/2025, 1/2/2026, 3/5/2026, 5/7/2026, 7/2/2026, 9/3/2026, 11/5/2026 Registered Nurse D/CF Level I: $62.99 - $76.57 hourly Registered Nurse … more
- Sacramento County (Sacramento, CA)
- Supervising Public Health Nurse *Revised Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/600083) Apply Supervising Public Health Nurse ... One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two years of...improperly rejected may request the Employment Services Division to review its decision to reject the application. If the… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $132,483.60 - $161,026.56 ... 9/26/2025, 10/24/2025, 11/26/25, 12/26/25, 1/23/26, 2/27/26, 3/27/26, 4/24/26, 5/22/26, 6/26/26 Nurse Practitioners provide a range of health care services involving… more
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