- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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 (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
- 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
- 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
- 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
- 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 (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
- 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
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