• Utilization Review Nurse Supervisor…

    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...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board… more
    The County of Los Angeles (09/30/24)
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  • Utilization Review Nurse

    Martin's Point Health Care (Portland, ME)
    …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 ensuring the ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as… more
    Martin's Point Health Care (09/24/24)
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  • Clinical Medical Review Nurse

    CareFirst (Cumberland, MD)
    …technology. + Must possess excellent verbal and written communication skills. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider… more
    CareFirst (11/15/24)
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  • Registered Nurse - Utilization…

    Mohawk Valley Health System (Utica, NY)
    Registered Nurse - Utilization Review Nurse - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case ... Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work experience. Preferred: + Associate… more
    Mohawk Valley Health System (10/28/24)
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  • Quality Review Nurse (Remote)

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse ( RN ) is to evaluate clinical quality and procedures within the Clinical Appeals & ... is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or… more
    CareFirst (11/15/24)
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  • Concurrent Review Nurse -( Auditor)-…

    InnovaCare (San Juan, PR)
    …to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization ... visits to Acute, SNF, and Rehabilitation Inpatient facilities to concurrently review admissions and continued stay to determine appropriate Utilization, Quality… more
    InnovaCare (10/16/24)
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  • Utilization Management & Quality Review

    UCLA Health (Los Angeles, CA)
    Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality care for ... candidate with: * A BSN or MSN degree, required * Current valid California RN license, required * Two or more years of experience in utilization management,… more
    UCLA Health (10/31/24)
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  • Utilization Review Registered

    Pipeline Health System, LLC (Toast, NC)
    Nurse - Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse ( RN ) position supports the Mission of Pipeline Health ... care to our patients. This position is responsible for utilization review , assessment of discharge planning needs and coordination of effective discharge… more
    Pipeline Health System, LLC (10/26/24)
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  • Licensed Practical Nurse (LPN)…

    The Arora Group (Bethesda, MD)
    …guidelines. + The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse ( RN ) and pre-certification clerk. ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed...or emergent patient care situations, seek assistance of the RN and/or MD/DO, and initiate appropriate emergency interventions as… more
    The Arora Group (11/22/24)
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  • Registered Nurse Peer Review

    Veterans Affairs, Veterans Health Administration (San Diego, CA)
    …the quality program within the facility. Responsibilities The Peer Review /Risk Management Registered Nurse ( RN ) assumes the following major duties and ... Summary The Peer Review RN is responsible for the...Summary The Peer Review RN is responsible for the documented outcomes at...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
    Veterans Affairs, Veterans Health Administration (11/16/24)
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  • Associate Nurse Mgr / UR Review

    Premier Health (Troy, OH)
    Position: ASSOCIATE NURSE MGR/ UTILIZATION REVIEW RN Dept: Inpatient Behavioral Health Shift: Full time 72 hours/pp: 7am-7:30pm Facility: Upper Valley ... POSITION: 24 HOURS/PP ASSOCIATE NURSE MANAGER AND 48 HOURS/PP UTILIZATION REVIEW RN ._** The **Associate Nurse Manager (ANM)-Inpatient Unit** serves as an… more
    Premier Health (11/07/24)
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  • Registered Nurse (Regional Quality…

    State of Georgia (Thomas County, GA)
    Registered Nurse (Regional Quality Review (RQR)) - Region 4 Georgia - Thomas - Thomasville ... main office for DBHDD is located in downtown Atlanta. Job Description Job Title: Registered Nurse ( Regional Quality Review (RQR) ) - Region 4 (Thomasville,… more
    State of Georgia (09/25/24)
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  • Clinical Review Nurse VHS- Woodland…

    Hackensack Meridian Health (Little Falls, NJ)
    …+ Home Care Experience Licenses and Certifications Required: + NJ State Professional Registered Nurse License. + Certificate for Oasis Specialist (COS-C, COQS, ... coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine that the coding… more
    Hackensack Meridian Health (11/14/24)
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  • Clinical Review Nurse -FT (Ocean…

    Hackensack Meridian Health (Brick, NJ)
    …+ Home Care Experience Licenses and Certifications Required: + NJ State Professional Registered Nurse License. + Certificate for Oasis Specialist (COS-C, COQS, ... coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine that the coding… more
    Hackensack Meridian Health (11/07/24)
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  • Utilization Review Nurse - Workers'…

    Travelers Insurance Company (Albany, NY)
    …parameters within their assigned state preferred. **What is a Must Have?** + Registered Nurse ; Licensed Practical Nurse or Licensed Vocational ... 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… more
    Travelers Insurance Company (11/21/24)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior ... months of Prior Authorization. **Education:** + Active and unrestricted RN licensure in state of residence **Questionnaire:** + Do... Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
    US Tech Solutions (10/18/24)
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  • Utilization Review Nurse - Full Time

    Dayton Children's Hospital (Dayton, OH)
    …Epic Systems (preferred) Education Requirements: Bachelors: Nursing (Required) Certification/License Requirements: [Lic] RN : Registered Nurse ( RN ) - Ohio ... Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical record review for medical necessity and… more
    Dayton Children's Hospital (11/19/24)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …experience as an RN . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… more
    US Tech Solutions (10/18/24)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
    US Tech Solutions (10/31/24)
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  • Clinical Review Nurse - Prior…

    Centene Corporation (Sacramento, CA)
    …flexibility. **Location: Position is 100% remote. Candidate must have CA RN Licensure.** **Position Purpose:** Analyzes all prior authorization requests to determine ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
    Centene Corporation (11/26/24)
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