- 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 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
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM ... (https://portal.ct.gov/dds/searchable-archive/northregion/north-region/welcome-to-the-north-region?language=en\_US) - is accepting applications for a full-time Utilization Review Nurse Coordinator… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 241023-5612FP-001 Location Middletown, CT Date Opened 11/5/2024 12:00:00 AM Salary $78,480 - ... Families (DCF (https://portal.ct.gov/dcf) ), seeks qualified individuals for a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) position.… 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
- 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
- Ascension Health (Tulsa, OK)
- …planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance ... **Additional Preferences** + 2+ years of bedside nursing experience + 2+ years of Utilization Review experience **Why Join Our Team** Ascension St. John has been… more
- BayCare Health System (Clearwater, FL)
- …team member be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Nurse - Health Plan **Location** ... **Experience:** + 2 years - Case Management + 2 years - Utilization Review + Directly working for Medicare Advantage Plan - preferred **Facility:** BayCare… 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
- 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
- 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
- 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
- UPMC (Hanover, PA)
- **UPMC is hiring a Professional Care Manager to support the Utilization Review process! This is a full time, day shift position with a rotating weekend and ... holiday schedule.** This is a nonpatient-facing position. This Registered Nurse is responsible for completing medical necessity reviews utilizing Indicia and… 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
- CVS Health (Columbus, OH)
- …on Fridays until 5pm Arizona Time. **Preferred Qualifications** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care - Strong ... to make health care more personal, convenient and affordable. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is 100% remote and… more
- CVS Health (Olympia, WA)
- …Long term care, cardiology -1+ years' experience in either Precertification or Utilization Review **Preferred Qualifications** -1+ years' experience Managed Care ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is fully remote and… more
- CVS Health (Sacramento, CA)
- …+ Candidates in PST preferred + 1+ years experience in either Precertification or Utilization Review highly preferred + 1+ years experience Managed Care + Strong ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is fully remote and… 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
- CVS Health (Hartford, CT)
- …in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record ... convenient and affordable. **Position Summary** This is a full-time remote Utilization Management Nurse Consultant opportunity. Utilization management… more