- Providence (Mission Hills, CA)
- **Description** ** RN Utilization Review - Remote . This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and ... must empower them. **Required Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience working… more
- CVS Health (Columbus, OH)
- …of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role in ... phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment to… more
- Dartmouth Health (Lebanon, NH)
- …communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote * Area ... of Interest:Nursing * Pay Range:$79,747.20/Yr. - $127,587.20/Yr. (Based on 40 hours per week, otherwise pro rata) * FTE/Hours per pay period:.01 hrs/per week (per diem/temp) * Shift:Rotating * Job ID:35880 Dartmouth Health offers a total compensation package… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- BJC HealthCare (St. Louis, MO)
- … RN experience performing care for hospitalized patients + 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity + ... team! This is a great opportunity for a local remote position. There is no communication with patients. This...Must have at least one active MO or IL RN license + If candidate only has one … more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or… 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
- Banner Health (Phoenix, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... better nursing. Our Care Management staff is seeking an RN Case Manager to work closely with members seeking...telephonic, home visits, and televisit platforms. It is fully remote with the exception of a few in person… more
- Bon Secours Mercy Health (Norfolk, VA)
- …clinical and operational excellence. **Summary of Primary Function** In the capacity of a Registered Nurse ( RN ), the Ambulatory Care Manager will provide ... Nursing Bachelor's Degree (preferred) Specialty/Major- Nursing (BSN) **Licensing/ Certification** Registered Nurse with active License in State of… more
- Tufts Medicine (Melrose, MA)
- …role is essential in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with ... managers, TMIN Practice Optimization Coaches (POMs) and primary care providers to review patient records, analyze data, and identify practice and patient outlier … more
- CVS Health (Little Rock, AR)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Trinity Health (Columbus, OH)
- …technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the coordination ... Director, Utilization Management. + Coordinates with the utilization review , case management, discharge planning staff...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… more
- Saint Francis Health System (Tulsa, OK)
- …secure link to patient rooms. Shift: 10a - 10p \#RNSIND Job Summary: The Registered Nurse I (Virtual) assesses, plans, implements and evaluates nursing care, ... works from an on-site office location (not a remote position) Will perform admit, discharge, chart review...Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 5… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ... ensuring that patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all levels of care. + Utilize strong… more
- Saint Francis Health System (Tulsa, OK)
- …from ER, ICU, and CTU units. + All private rooms Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the ... therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related… more
- Sedgwick (Cincinnati, OH)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **Join us in a hybrid capacity, combining ... Blue Ash, OH office.** **PRIMARY PURPOSE** : To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.… more
- US Tech Solutions (Columbia, SC)
- **Location: Columbia, SC 29229 ( Remote after training)** **Duration: 3+ Months Contract (Possible temp to hire)** **Job Description:** + Must be an RN in SC and ... have an active and unrestricted SC RN license. + Hours/Schedule - Monday through Friday, 8:30am-5:00pm....8:30am-5:00pm. + Onsite training for the first 1-2 weeks remote position after training. + Reviews and evaluates medical… more
- Humana (Lincoln, NE)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Children's Mercy Kansas City (Kansas City, MO)
- …+ Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of...One of the following: Licensed RN - Kansas, Registered Nurse … more
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