- 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
- 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 ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use... Review prior authorization requests (prior authorization, concurrent review , and retrospective review ) for medical… 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
- Humana (Columbus, OH)
- …communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently ... first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical...state of Ohio. + 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience… more
- University of Washington (Seattle, WA)
- …) **UW Medical Center** has an outstanding opportunity for an **experienced Utilization Review Nurse (UM RN)** to join our team. **WORK ... Req #: 236354 Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT Job...training + Active licensure to practice as a Registered Nurse in Washington State required by start date +… more
- Glens Falls Hospital (Glens Falls, NY)
- …week, can be foundhere. **Job:** **Nursing - Case Management* **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** ... Will Fulfill Your Potential* *Responsibilities* * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ) medical necessity criteria to monitor… more
- Ascension Health (Wamego, 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
- 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
- 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
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... providing temporary contracted medical services to Military Treatment Facilities throughout the United...Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP), Certified Informatics Nursing,… more
- Crouse Hospital (Syracuse, NY)
- …while maintaining the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent and continued stay ... education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage data and… more
- Actalent (Santa Barbara, CA)
- …Health Plan Nurse Coordinator Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a contract basis! ... to work a 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote...with a leading healthcare organization Description: The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse … more
- Cleveland Clinic (Weston, FL)
- …Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM data ... Utilization Management Specialist Join Cleveland Clinic Weston Hospital's...Management (UM) Specialists perform UM activities, such as admission review , concurrent review , retrospective chart review… more
- VNS Health (Manhattan, NY)
- …components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, ... Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies… more
- CVS Health (Trenton, NJ)
- …experience in post-acute setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record systems such ... convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization management… more
- Texas Health Resources (Arlington, TX)
- **RN/Registered Nurse - Utilization Management, Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort Worth ... process when indicated. Assist and facilitate the physician peer-to-peer review process with insurance medical directors as...care team. + Determine working DRG with each initial review via CareConnect1 or other Utilization Management… 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
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