• Utilization Review Nurse

    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
    The County of Los Angeles (12/29/24)
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  • Utilization Review Nurse (RN)

    Matrix Providers (Aurora, CO)
    Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... provider-to-patient ratios and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to join our team of talented… more
    Matrix Providers (01/29/25)
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  • Utilization Review Nurse

    Independent Health (Buffalo, NY)
    …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… more
    Independent Health (03/14/25)
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  • Utilization Review Nurse

    Lawrence General Hospital (Lawrence, MA)
    The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for ... compliance with the conditions of participation as they relate to Utilization Review and Discharge planning and payer regulations. Graduate of an accredited… more
    Lawrence General Hospital (03/09/25)
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  • Utilization Review Nurse

    CDPHP (Albany, NY)
    …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
    CDPHP (03/12/25)
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  • Licensed Practical Nurse (LPN)…

    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
    The Arora Group (02/20/25)
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  • Utilization Review Nurse

    Beth Israel Lahey Health (Burlington, MA)
    …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
    Beth Israel Lahey Health (02/14/25)
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  • Utilization Review Nurse

    Beth Israel Lahey Health (Burlington, MA)
    …Rotation **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
    Beth Israel Lahey Health (02/14/25)
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  • Utilization Review Nurse

    University of Utah Health (South Salt Lake, UT)
    …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
    University of Utah Health (02/08/25)
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  • Utilization Review Nurse

    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
    US Tech Solutions (01/17/25)
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  • Utilization Review Nurse

    Dignity Health (Chandler, AZ)
    …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
    Dignity Health (03/13/25)
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  • Utilization Review Nurse

    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 (01/17/25)
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  • Case Manager Utilization Review

    Beth Israel Lahey Health (Burlington, MA)
    …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… more
    Beth Israel Lahey Health (02/09/25)
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  • RN, Utilization Review Flexi

    Chesapeake Regional Healthcare (Chesapeake, VA)
    Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization ... as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical… more
    Chesapeake Regional Healthcare (02/16/25)
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  • RN- Utilization Review

    Baptist Memorial (Memphis, TN)
    Overview  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
    Baptist Memorial (03/14/25)
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  • LVN - Quality Assurance/ Utilization

    Emanate Health (Covina, CA)
    …the United States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices....support and review of medical claims and utilization practices. Complete medical necessity and level of care… more
    Emanate Health (01/22/25)
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  • RN - Utilization Review

    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
    Health Advocates Network (02/08/25)
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  • Case Manager (RN), Utilization Management

    Children's Hospital Boston (Boston, MA)
    …Hours per Week:40 Job Posting Category:NursingJob Posting Description:The Utilization Review Nurse will be ... with established procedures, guidelines and criteria + Focusing on high priority utilization review activity including: conducting emergency admission level of… more
    Children's Hospital Boston (03/05/25)
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  • Utilization Management Denial Review

    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
    UCLA Health (12/23/24)
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  • Utilization Review (UR) Registered…

    Community Health Systems (Naples, FL)
    …Benefits **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
    Community Health Systems (02/20/25)
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