- 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 ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Martin's Point Health Care (Portland, ME)
- …Point 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 ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… 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 ... compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work experience.… more
- Pipeline Health System, LLC (Toast, NC)
- Job Title: Utilization Review Registered Nurse - Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse (RN) ... compassionate care to our patients. This position is responsible for utilization review , assessment of discharge planning needs and coordination of effective… 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 New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan...required * Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in ... will be required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties… more
- Actalent (Omaha, NE)
- …in medical review or utilization management. + Knowledge of utilization review , Medicare, utilization management, and EMR systems. Additional Skills ... Utilization Management NurseJob Description We are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? ... 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior...and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1… more
- Travelers Insurance Company (Buffalo, NY)
- …**What Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for ... do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual...to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ..... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- TEKsystems (Austin, TX)
- Job Summary + The Medical Records Utilization Case Manager will support documentation of medical necessity by facilitating medical records (MR) collection and client ... outreach, by offering expert review and interpretation on a case by case basis,...as a source of knowledge for medical records (MR) review and interpretation, including in-depth review of… more
- Baptist Memorial (Jackson, MS)
- Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as ... prescribed by utilization review standards. The UR Nurse works with providers, insurance companies and patients to ensure cost-effective and appropriate… more
- Health Advocates Network (Medford, OR)
- … Review experience. * Pay Rate: $2,608 weekly * Specialty: Discharge Planning and Utilization Review Registered Nurse (RN) * Shift: Day * 13 Week ... School of Nursing * 2 years of experience as a Discharge Planning and Utilization Review Registered Nurse (RN) * American Heart Association BLS * An active,… more
- LifePoint Health (Hancock, MI)
- …growth of our employees both professionally and personally. We are seeking a detail-oriented Utilization Review Registered Nurse to be responsible for prior ... testing along with determining medical necessity of patient while hospitalized. Our Utilization Review RN will be part of an excellent team of Case Management… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- Trinity Health (Fort Lauderdale, FL)
- **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of ... requirements of various commercial and government payers. On-Site Position** **_Position Purpose:_** Utilization Review (UR) Nurses play a vital role in… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... conducting centralized clinical review and authorization creation for centrally-authorized services. This position has a key role in ensuring CCA meets CMS… more
- Ascension Health (Manhattan, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Humana (Boise, ID)
- …interpretation and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
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