- Careerbuilder-US (Atlanta, GA)
- …have a VA or compact state RN license . . Must have requirement: Utilization Management experience . Day-to-day: Review cases for medical necessity Summary: . ... Job Title: Utilization Review Nurse I Location: 100% Remote...Works with the Utilization Management team primarily responsible for inpatient medical… more
- TalentBurst, Inc (Irving, TX)
- …criteria in order to determine appropriate level of care * Resource/ Utilization Management appropriateness: Assess assigned patient population for medical ... with tax-free stipend amount to be determined. Posted job title: Registered Nurse Utilization Review \ 1366About TalentBurst, IncTalentBurst Health & Life… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …organizational standardization. Participates in identifying expanded use of and improvement management utilization of NGHS continuum. Participates in identifying ... weekly inpatient unbilled accounts and meets organizational financial targets. Assures concurrent financial management of the patient's account focusing on… more
- UT Health Tyler (Tyler, TX)
- …care team. Plans and coordinates a comprehensive plan of care using a concurrent integrated review, standard operating procedures, case management tools, and ... team as a full-time, day shift, Case Manager Registered Nurse in Tyler, TX. Fulfilling your purpose begins here:...of patients across the continuum promoting quality care, effective utilization of resources and assuming a leadership role with… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... assigned at any time with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level… more
- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily...documents, and codes and reports the data to the Utilization Management Inpatient Coordinator and Inpatient Nurses.13.… more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- McLaren Health Care (Detroit, MI)
- …**Essential Functions and Responsibilities as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... **Department: Utilization Management ** **Daily Work Times: 9:00am-5:30pm**...to support the level of care being billed. Conducts concurrent reviews to ensure criteria for patient status and… more
- McLaren Health Care (Detroit, MI)
- …**Essential Functions and Responsibilities as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...support the level of care being billed . Conducts concurrent reviews to ensure criteria for patient status and… more
- Health First (Melbourne, FL)
- …vehicle. **Job:** **Case Management * **Organization:** **Holmes Regional Medical Center* **Title:** * Utilization Review Nurse - Case Management UR Part ... *POSITION SUMMARY* The Utilization Review (UR) nurse performs medical...as necessary. 7. Is an active member of the Utilization Management Committee. *MINIMUM QUALIFICATIONS* *Education:*Associate's Degree… more
- Beth Israel Lahey Health (Needham, MA)
- …**Job Description:** **Essential Functions and Responsibilities:** Performs a variety of concurrent and retrospective utilization management -related reviews ... payer certification, and denied cases. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- Beth Israel Lahey Health (Burlington, MA)
- …identifies delays. **Essential Functions and Responsibilities:** Performs a variety of concurrent and retrospective utilization management -related reviews ... payer certification, and denied cases. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- Martin's Point Health Care (Portland, ME)
- … required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment required ... certified as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a team responsible for… more
- University of Virginia (Charlottesville, VA)
- …conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission ... Under general direction: The Utilization Management RN serves as a...hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. PREFERRED REQUIREMENTS… more
- University of Virginia (Charlottesville, VA)
- …conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission ... Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management … more
- Martin's Point Health Care (Portland, ME)
- …+ 3+ years of clinical nursing experience as a RN, with a focus of Utilization Management in a managed care environment. + Medicare experience required. + Coding ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...guide medical necessity reviews and will use effective relationship management , coordination of services, resource management , education,… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... **REQUIREMENTS** None. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** Full Time, 40 hours weekly, Monday - Friday 7:30am - 4pm + **Hospital:** Ascension Via ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Intermountain Health (Murray, UT)
- …practice. + Three years clinical nursing experience. + One year in Managed Care, Utilization Management , or Case Management . + Basic computer skills ... knowledge of Medicare, Medicaid and Commercial insurance. + Current working knowledge of utilization management and case management techniques. + Working… more
