- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care… more
- Datavant (Nashville, TN)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials ...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- CommonSpirit Health (Centennial, CO)
- …as a Registered Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial appeal letters ... indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... this position is able to cover a multitude of utilization review functions through point of entry,...point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications...4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials , and appeals KPIs, trends, patterns,… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... to infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... Patient Accounting Centers (CPAC) for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to… more
- CDPHP (Latham, 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 ... determinations and appropriate exceptions, coordinating with Medical Directors on denials . In addition, the UR nurse is...of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... level of care, length of stay and authorization Prevents denials and disputes by communicating with payors and documenting...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- Dartmouth Health (Lebanon, NH)
- …with pre-certifications. * Assumes responsibility for the oversight of inpatient denials , including, but not limited to, reviewing denial letters, collaborating with ... communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote * Area of… more
- Baylor Scott & White Health (Dallas, TX)
- **JOB SUMMARY** The Utilization Review Registered Nurse (RN) provides a clinical review of cases using medical necessity criteria to determine the ... outpatients) or type of service. Alerts and collaborates with appropriate Utilization Review , Physician leadership and/or Provider Team personnel concerning… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Dignity Health (Rancho Cordova, CA)
- …within driving distance of the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may...the cases. - Watches for follow up and processes denials as indicated, demonstrating wording at 8th grade level,… more
- PeaceHealth (Bellingham, WA)
- …of psychiatric diagnostics. + Preferred: Third party reimbursement knowledge. + Preferred: Utilization Review experience, someone who can talk to providers. ... **Description** PeaceHealth is seeking a RN Admissions/ Utilization Behavioral Health - Care Management for a...and follow-up on payer authorization. + Complete UR Admission review and Concurrent review processes. Ensure best… more