- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization ... resources as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of… more
- Bon Secours Mercy Health (Newport News, VA)
- …**This is a PRN position at Mary Immaculate Hospital** **Licensing/ Certification** + Acute Registered Nurse ( RN ) (required) + BLS Basic Life Support - ... rules and regulations and Conditions of Participation for DC Planning and Utilization Review , and address opportunities or potential concerns with leadership.… more
- Select Medical (Newport News, VA)
- …Illness Recovery Hospital** **Director of Case Management** **_Clinical license as a registered nurse or respiratory therapist or master's in social work ... and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan… more
- Fresenius Medical Center (Chesapeake, VA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Humana (Newport News, VA)
- …supports the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will review prior authorization requests for appropriate ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will...using clinical judgment and refers to internal stakeholders for review depending on case findings. + Educates providers on… more
- Elevance Health (Norfolk, VA)
- …Focuses on relatively complex case types that require the training and skill of a registered nurse . Acts as a resource for more junior Clinicians. **How you'll ... a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid... experience. + Current active, valid and unrestricted + RN license and/or certification to practice as a health… more
- Elevance Health (Norfolk, VA)
- …Health PulsePoint office. This utilization management role is responsible for utilization management review for Behavior Analysis services. **How you will ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...is licensed staff supervision. + Previous experience in case management/ utilization management with a broad range of experience with… more
- Molina Healthcare (Hampton, VA)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse or LCSW who lives in VIRGINIA and must be licensed for the state of VIRGINIA. ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …duties as assigned. + LICENSES AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...required. + Three to five years of case management utilization review , or compliance related work experience… more
- Elevance Health (Norfolk, VA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... **Medical Management Nurse ** **Federal Employee Program - FEP** , a...an equivalent background. + Current active, valid, and unrestricted RN license and/or certification to practice as a health… more