- CVS Health (Frankfort, KY)
- …care more personal, convenient and affordable. **Position Summary** This is a fully remote Utilization Review Clinical Consultant. **MUST RESIDE IN ... state licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with active...reside in state of Kentucky **Preferred** **Qualifications:** + Managed care/ utilization review experience preferred + Experience in… more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr ... other events, as directed by their Leader. **Required Qualifications** + Active and unrestricted Registered Nurse in state of residence + 3+ years of experience… more
- Swedish Health Services (Seattle, WA)
- **Description** ** Utilization RN ** **Per diem** ** Remote Day shift** The Utilization Review (UR) Nurse has a strong clinical background blended ... with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination....an accredited school of nursing. + Upon hire: Washington Registered Nurse License. + 3 years … more
- Dartmouth Health (Lebanon, NH)
- Overview Utilization Review ( RN ) - Remote Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. ... skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote * Area of Interest:Nursing * Pay… more
- Ochsner Health (New Orleans, LA)
- …a difference at Ochsner Health and discover your future today!** This job is a registered Nurse with a diverse medical background, who is able to determine the ... members as well as post-acute care and third party payers. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1 year… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Utilization Management (UM) Registered Nurse ( RN ) executes position responsibilities that demonstrate leadership, experience, and creative ... Registered Nurse 3 years of Utilization Management/Chart Review / Utilization Review...medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- Summary Registered Nurse ( RN ) Utilization Management (UM) delivers knowledge-based care to clients while developing technical skills. Assesses, plans, ... The Nurse Utilization Management (UM) Registered Nurse ( RN ) is responsible...care Bachelor of Science in Nursing Case Management Experience Utilization Management/ Review experience Physical Requirements: Heavy lifting… more
- Ochsner Health (New Orleans, LA)
- …Works independently with minimal supervision under the direction of Registered Nurse Case Managers. Communicates the clinical review either verbally or in ... writing to insurance companies, Registered Nurse Case Manager or other members...the discharge plan. + Under the direction of a RN Case Manger performs utilization review… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... of acute/critical care experience preferred. 3 years of case management, utilization management, disease management, auditing or retrospective review experience… more
- AmeriHealth Caritas (Florence, SC)
- ** Remote to qualified candidates living in South Carolina...BSN required and must hold a current and unrestricted Registered Nurse ( RN ) license in ... plan of care, referrals, and evaluation of the effectiveness of the plan.; 2. Review medication list and educate Members with pharmacy needs, and counsel on side… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands ... utilization review and coverage guidelines for multiple payers; + Identifies...Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. … more
- Medical Mutual of Ohio (OH)
- …Ohio State Nursing Board. Bachelor's degree preferred + 3 years' experience as a Registered Nurse in acute care, critical care, emergency medical or medical ... medical coding or medical documentation investigation preferred Professional Certification: + Registered Nurse with current State of Ohio unrestricted license… more
- Veterans Affairs, Veterans Health Administration (Muskogee, OK)
- …Helping Invest through Property and Improvements Needed for Veterans Act 2016. Responsibilities Registered Nurse ( RN ) is responsible for providing competent, ... utilization . The Clinical Transfer Coordinator (CTC) is a registered nurse who is directly responsible to...to prioritize and track issues, tasks, statistical data and utilization review related duties in a self-directed… more
- Veterans Affairs, Veterans Health Administration (MO)
- …and administering medications and treatments. Responsibilities The Community Care (CC) Coordinator Registered Nurse ( RN ) is responsible for executing a ... Summary The Registered Nurse - Community Care Coordinator...intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …at the Buffalo Location. The Resident Assessment Coordinator (Community Living Center) Registered Nurse ( RN ) executes position responsibilities that ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...Western New York VA Medical Center is seeking a Registered Nurse - Resident Assessment Coordinator to… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- …as directed by supervisors. Duties include but not limited to: Inpatient Staff Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... of Science in Nursing Minimum of 1-2 years experience as registered nurse Previous acute care experience Experience administering chemotherapy/biotherapy… more
- Veterans Affairs, Veterans Health Administration (Canandaigua, NY)
- …The Nurse II Community Living Center (CLC) Minimum Data Set (MDS) Registered Nurse ( RN ) is responsible for providing competent, evidence-based care ... This position will be a hybrid of a clinical nurse and RN Care Coordinator. The position...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- … of the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Dialysis Registered Nurse ( RN ) is a professional nurse with ... BSN 3-5 Years Med/Surg or Critical Care experience At least 1 year of recent registered nurse dialysis experience Caring for acute and , chronic Hemodialysis and… more
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