- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251119-5613FP-001 Location Middletown, CT Date Opened 12/11/2025 12:00:00 AM Salary ... Campus Hospital (https://portal.ct.gov/dcf/solnit-center/south) - is accepting applications for a Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) (REGULATORY) position,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management, concurrent… more
- UNC Health Care (Kinston, NC)
- …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... Coordinates and leads all clinical denial processes and clinical audit activities. Collaborates with teammates involved in the denial...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review,… more
- CVS Health (Columbus, OH)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you'll ... Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of the Customer...teams to execute our strategic plan for AwareUM. + Audit for product accuracy and effectiveness, communicating with product… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Bachelor's Degree in Nursing; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) ... acute care or clinical experience in area of specialty. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** + Master's… more
- McLaren Health Care (Mount Pleasant, MI)
- …6. Provides support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process are met, including ... sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - F/C - 67072411 APD/ DDDP CHATTAHOOCHEE, FL Date: Dec 9, 2025 The State Personnel System is an E-Verify employer. For more information ... Requisition No: 866210 Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - F/C - 67072411 APD/ DDDP CHATTAHOOCHEE, FL Pay Plan:… more
- Molina Healthcare (TX)
- **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for ... for Quality Assurance (NCQA) guidelines, and other applicable requirements. + Distributes audit results letters, follow-up letters, audit tools and annual… more
- Commonwealth of Pennsylvania (PA)
- Registered Nurse Supervisor - Selinsgrove Center Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5133037) Apply Registered Nurse ... Human Services is seeking a dependable and compassionate Registered Nurse Supervisor to lead our nursing staff at Selinsgrove...people residing in your assigned area. You will also audit the delivery of nursing services and related health… more
- STG International (Milledgeville, GA)
- …FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure ... (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate...+ Coordinate with the scheduler to ensure a Registered Nurse (RN) is on duty at least 8 hours… more
- State of Colorado (Pueblo, CO)
- …and manages playback to ensure accurate monitoring of assigned wellness checks. + The Nurse Manager or Department Leader documents audit findings on paper forms, ... Nurse I - RN Critical Incident/Occurrence Reporter-CMHHIP-Pueblo Print...and tied to CMHHIP's improvement goals. + Participate in utilization management and review activities when requested, applying clinical… more
- Immigration and Customs Enforcement (Washington, DC)
- …clinical and administrative nursing support, and collaborating with the IHSC Chief Nurse in the Nursing Services Unit to implement initiatives aimed at enhancing ... needed interpretation and/or translations services are available. d. The correctional registered nurse practices ethically per the Code of Ethics for Nurses with… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …processes as requested by service. Serves as a preceptor for graduate nurse practitioner students. Impact Unit Section Chief Duties: Plans, controls, organizes, and ... to ensure compliance and successful outcomes for any site visit or audit . Establishes, assesses & revises policies and procedures for administrative & clinical… more
- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with ... supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational… more
- MyFlorida (Marianna, FL)
- REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - ALL SHIFTS) Date: Dec 9, 2025 The State Personnel System is an E-Verify employer. For more information ... No: 844947 Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - ALL SHIFTS) Pay Plan: Career… more
- Banner Health (Worland, WY)
- …Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process including new resident ... patients undergoing treatments. This role is best suited for an experienced nurse or an eager nurse wanting to grow into the role for this specialty. **BLS… more
- Elevance Health (GA)
- ** Nurse Case Manager Senior - Field Nurse ** **Work location:** This field-based role located in the Jonesboro, GA area enables associates to primarily operate in ... complete the assessment within 48 hours of receipt and meet the criteria._** The ** Nurse Case Manager Senior - Field Nurse ** is responsible for care management… more
- HCA Healthcare (Richmond, VA)
- …We care like family! Jump-start your career as a Clinical Research Nurse today with Chippenham Hospital. **Benefits** Chippenham Hospital offers a total rewards ... for benefits may vary by location._** Come join our team as a Clinical Research Nurse . We care for our community! Just last year, HCA Healthcare and our colleagues… more
- HCA Healthcare (Savannah, GA)
- …We care like family! Jump-start your career as a Clinical Research Nurse today with Memorial Health University Medical Center. **Benefits** Memorial Health ... for benefits may vary by location._** Come join our team as a Clinical Research Nurse . We care for our community! Just last year, HCA Healthcare and our colleagues… more