- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working in… more
- Abbott (Kansas City, MO)
- …a schedule of **Monday-Friday, 8:00 AM - 5:00 PM** . The position of Clinical Review Nurse is within our Toxicology division located at our **Kansas City, MO** ... site within Workplace Solutions. In this role, the **Clinical Review Nurse ** is responsible for accuracy and integrity of the Workplace Solutions drug testing … 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 NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… 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, ... and cost-effective care. Additionally, this position oversees the Infection Control Nurse to ensure adherence to infection prevention protocols and regulatory… more
- System One (Baltimore, MD)
- Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224 Type: Contract, 5 mos with chance of extension Compensation: Based on experience starting ... occassional travel to providers for record retrieval, as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist Schedule: 8-hour shifts… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- Actalent (St. Louis, MO)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within a leading Managed...to gather additional information when needed. + Document all review decisions clearly, accurately, and in compliance with regulatory… more
- Veterans Inc. (Shrewsbury, MA)
- …their families in New England, is seeking to fill the Inpatient Behavioral Health Admission Review Nurse position and become a valued member of the Veterans Inc. ... valued. + Must have a current and valid Massachusetts licensure as a Registered Nurse + Current certification in CPR + Minimum of one year of nursing experience… 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 ... 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,...Registered Nurse required. + 2 years utilization review , care management, or compliance experience preferred. + Minimum… 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:...care and compliance with established guidelines. Key Responsibilities + Review and approve precertification and medical necessity for designated… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within ... **Licenses/Certifications Upon Hire Required:** + Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. **Experience:** 5… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... Nurse issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- STG International (Rockville, MD)
- STGi is currently seeking a Registered Nurse -Case Review Specialist . The position is remote and open to candidates nationwide. JOB SUMMARY: Provides direct ... service delivery with FOH Business Operations team. Serves as a Registered Nurse Case Review Specialist for the case review process to include ensuring… more
- Cedars-Sinai (Los Angeles, CA)
- …Motions, Eye/Hand/Foot Coordination **Req ID** : 14355 **Working Title** : Registered Nurse -Utilization Review Case Manager - 8 Hour Days **Department** ... Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge clinical… more
- Cedars-Sinai (Los Angeles, CA)
- …necessity reviews with accepted criteria required **Req ID** : 14141 **Working Title** : Registered Nurse - Utilization Review Case Manager - PER DIEM - 8 Hour ... will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be...follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. +...3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior… more
- Molina Healthcare (Rio Rancho, NM)
- …**Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory ... and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review , appropriate… more
- Centene Corporation (Jefferson City, MO)
- …on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine ... quality, cost efficiency, and are within compliance. + Performs a clinical review and assessment of relevant complex post-care services by reviewing medical records… more
- University of Utah Health (Salt Lake City, UT)
- …appropriateness of admissions with associated levels of care and continued stay review . + Communication to third-party payers for initial and concurrent clinical ... review . + Reviews patient chart to ensure patient continues...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Actalent (Baton Rouge, LA)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the ... healthcare providers and the authorization team to ensure timely review of services and requests, ensuring members receive authorized...years of related experience. + LPN - Licensed Practical Nurse - State Licensure required. + RN license required… more
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