- Point32Health (MA)
- …are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected ... Precertification Team Manager or department Manager. The Clinical Reviewer is expected to demonstrate the...+ **EDUCATION:** + Bachelor's degree in Nursing preferred + Registered Nurse with a current and unrestricted… more
- Ascension Health (Austin, TX)
- …with your Talent Advisor for additional specifics._ **Responsibilities** As the Utilization Review RN , you'll provide health care services regarding admissions, ... **Details** + **Department:** Utilization Review + **Schedule:** Full-time, 8-hour day shift, Monday-Friday,...and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date… more
- NJM Insurance (Trenton, NJ)
- …Improvement initiatives. + Keep current with regulation changes. Required Qualifications and Experience: + Registered Nurse ( RN ) in New Jersey + 3 + years ... needs. + Collaborate with treatment providers to promote rehabilitation. + Review clinical information and perform utilization management, concurrent and… more
- Trinity Health (Albany, NY)
- …other related duties as assigned Experience and Requirements + Active Licensure as a registered nurse , preferably with a **bachelor's degree** in nursing from an ... Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals...accredited school and Certified Registered Rehab Nurse preferred (CRRN). + A… more
- AdventHealth (Glendale Heights, IL)
- …years of position-related experience preferred_** **LICENSURE, CERTIFICATION OR REGISTRATION:** * Registered Nurse credentialed from the Illinois Board of ... calls; and initiates contact with Managed Care companies, including precertification and benefit information. The Intake Planner makes arrangements for… more
- Access Dubuque (Dubuque, IA)
- … - Rehab - FT - Days MercyOne MercyOne Dyersville Senior Care Day Shift RN Charg MercyOne Registered Nurse Hillcrest Family Services Certified Nurse ... We are faithful to those we say we are. MINIMUM QUALIFICATIONS Must be a registered nurse and must hold an active license to practice nursing in the… more
- Point32Health (Canton, MA)
- …perform the job** **Education, Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted MA license preferred. + ... the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, Inpatient & Outpatient) for… more
- Elevance Health (Norfolk, VA)
- …serve as a resource to less experienced staff. Examples of such functions may include: review of precertification request, level of care review for inpatient ... or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum...unrestricted license or certification as a LPN, LVN, or RN to practice as a health professional within the… more
- Hackensack Meridian Health (Neptune, NJ)
- …insurance payers to convey and communicate to clinical care givers (Physicians, Nurse Practitioners and RN case managers. + Ability to deal effectively and ... treatment, status of treatment and authorization status in appropriate format for vendor review . + Provide clarification to clinical care team if clarification… more
- Katmai (Usaf Academy, CO)
- …for inpatient/outpatient precertification . **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to ... the Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. +...+ Must possess a current, active, full, and unrestricted Registered Nurses ( RN ) licensed in Colorado, be… more
- CVS Health (New Albany, OH)
- …Following training, position is remote with occasional in office requirement.** Utilization Review - Precertification Nurse is responsible for telephonically ... are health care innovators. **Fundamentals:** Through the use of clinical tools and information/data review , conducts an...NC, or New Albany, OH - 3+ years of clinical practice experience as an RN required… more
- Elevance Health (Tampa, FL)
- Senior RN Utilization Review /Management (Acute InPatient) JR116937 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is ... medical policy, and member eligibility, benefits, and contracts. + Conducts precertification , continued stay review , care coordination, or discharge planning… more
- Beth Israel Lahey Health (Boston, MA)
- …taking a job, you're making a difference in people's lives.** The role of the RN Case Manager Emergency Department (ED) is to increase patient throughput to the most ... level of care while facilitating interdisciplinary care across the continuum. The RN Case Manager ED will assist in identifying patients appropriate for Admission,… more
- Elevance Health (KS)
- …appeals for services denied. How you will make an impact: + Conducts precertification , continued stay review , care coordination, or discharge planning for ... can be located anywhere within 50 miles of our Elevance PulsePoints. **The Nurse Medical Management II** is responsible to collaborate with healthcare providers and… more
- Elevance Health (Austin, TX)
- …medical policy, and member eligibility, benefits, and contracts. + Conducts precertification , continued stay review , care coordination, or discharge planning ... ** Nurse Medical Management Sr.** **Location:** **multiple states: Texas,...May also manage appeals for services denied. + Stay review , care coordination, and discharge planning for appropriateness of… more