- USAA (Phoenix, AZ)
- …Interprets relevant medical literature for application to appropriate health insurance underwriting policies and guidelines. Applies advanced medical expertise by ... Participates in special project work, particularly involving the automated review of digital health data. Reviews and interprets relevant...include 6 years of experience working as a Registered Nurse (RN), Nurse Practitioner (NP), or Medical… more
- 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,...+ The Contractor shall perform pre-cert and authorization of insurance pertaining to patient admission and surgical admission as… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people,… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to join our team...hour + Benefits: Competitive financial package with a comprehensive insurance package including health, dental, vision, and life coverage.… more
- HCA Healthcare (Webster, TX)
- …your knowledge and expertise! **Job Summary and Qualifications** We are seeking a Registered Nurse (RN) Quality - Peer Review Coordinator for our facility to ... **Description** **Introduction** Do you have the career opportunities as a(an) RN Peer Review Coordinator you want with your current employer? We have an exciting… more
- Actalent (Dallas, TX)
- …Management NurseJob Description We are seeking a dedicated Utilization Management Nurse to review handwritten and computer-generated documents, ensuring tasks ... are prioritized effectively. The nurse will be responsible for assessing medical necessity for...inpatient stays and coordinating with medical directors for further review if criteria are not met. This role involves… more
- Actalent (San Antonio, TX)
- Job Title: Registered Nurse - Utilization ManagementJob Description We are seeking a dedicated Registered Nurse with a strong background in utilization ... inpatient stays, and managing authorization processes efficiently. Responsibilities + Review handwritten and computer-generated documents while prioritizing tasks effectively.… more
- Elevance Health (Harrisburg, PA)
- **Clinical Review Nurse I - Medicare Part B** National Government Services is a proud member of Elevance Health's family of brands. We administer government ... pm EST or CST. Hours are flexible.** The **Clinical Review Nurse I** is responsible for reviewing...term disability benefits, 401(k) +match, stock purchase plan, life insurance , wellness programs and financial education resources, to name… more
- Actalent (Houston, TX)
- …NurseJob Description We are seeking a dedicated and detail-oriented Utilization Management Nurse to oversee and review both handwritten and computer-generated ... with the Utilization Management department at hospitals. Responsibilities + Review handwritten and computer-generated medical documents. + Prioritize tasks… more
- Actalent (Houston, TX)
- Job Title: Prior Authorization Nurse (Must be located in Texas) Job Description + We are seeking a dedicated Prior Authorization Nurse to routinely reviews prior ... TX RN or LVN License + Experience in utilization management and concurrent review + Strong communication skills + Proficiency in computer and documentation tasks… more
- Ascension Health (Baltimore, MD)
- …- $111,820.80 per year **Benefits** Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans ... care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and service requests within… more
- Centene Corporation (Sacramento, CA)
- …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
- Centene Corporation (Sacramento, CA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... with the ability to interact with patients/family, clinical staff, insurance providers and post-acute care providers. **Responsibilities:** + Conducts admission… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …experience providing direct patient care with one year of authorization, medical review experience and case management is required **Skills and Abilities** + ... maintaining performance standards is required + Knowledge of health insurance contracts/benefits is preferred **Licenses and Certifications** + Current, unrestricted… more
- CVS Health (Oklahoma City, OK)
- …available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. ... CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** 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
- Guthrie (Towanda, PA)
- Up to a $15,000.00 Sign on Bonus! Summary The Wellness Nurse plays a key role in health promotion and illness prevention of patient populations through ... nursing-patient collaboration and patient education. This nurse performs the Medicare Annual Wellness Visit under the direct supervision of a physician (physician on… 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
- Travelers Insurance Company (Alpharetta, GA)
- …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 ... continuous process of management involvement and frequent claim file review . Serve as a field representative for the Home...essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state… more
